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Needing info on code 99211

  1. #1
    Default Needing info on code 99211
    Medical Coding Books
    I recently attended a webinar for clairification on the 99211...needless to say I am even more confused as to what we can bill. If a nurse sees the pt for 5 minutes...what is required in order to bill 99211. According to IMS recording vitals, blood draw and injections are not grounds to bill that code. My understanding was that we could bill if the nurse did vitals. can someone please point me in the correct direction or give me some clairification on what and when to use a 99211. thanks

  2. #2
    Milwaukee WI
    Default What's the purpose of the visit?
    The only real requirement for a 99211 visit is a chief complaint.

    Is the patient coming in just to have BP checked because s/he is being followed for HTN? Then it is probably a 99211.

    Or is the patient coming in for an injection, and the nurse takes vitals because they always do this before the injection? Then you code only the injection and don't code any E/M (because you do not have a significant separately reportable E/M service)

    Or is the patient coming in for an injection, and "by the way" has a stuffy nose ... so the nurse takes vitals, asks about fevers or other associated symptoms and says "take two aspirin and call again if you get worse." Here you have a separately reportable 99211 E/M (don't forget your -25 modifier) and an injection administration.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    I don't know about anyone else but that sure did help me!! Thanks FTessa!

  4. #4
    Columbia, MO
    Except a nurse may not assess dx and treat a new problem. To bill a 99211 for a nurse only type encounter, it must meet the definition of incident-to.. meaning this visit is incident to a visit with the physician, the physician must have already seen the patient for the same problem and must have a plan of care documented that includes for followup encounters by nursing staff. A blood pressure check will meet this definition providing the patient is following docs orders to come in for same. There is much written that says you may not bill a 99211 for a blood draw or for injections, just as pointed out, merely taking vital signs does not make it significant. I hope this provides more clarification.

  5. Default
    does the name of the physician that referred the patient to the nutritionist go on the claim even if they are not in the office or do we bill under a physician that is in the office at the time of service

  6. #6
    Columbia, MO
    The name of the physician that saw the patient for the same dx goes in box 17 and NPI in 17b, The supervising physician NPI goes in 24J

    Debra A. Mitchell, MSPH, CPC-H

  7. Default 99211
    Can an MSW or LCSW bill 99211 for a clinic visit?

  8. Default
    I will like to show my providers an article showing it is not approiate to bill the 99211 if the patient is just coming in for an injection. Can someone show me one?

  9. Default
    If I only new how to spell "appropriate".....sorry long day.....

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