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billing a 99211 when the office calles in Rx

  1. #1
    Question billing a 99211 when the office calles in Rx
    Medical Coding Books
    I do physician coding & billing for a small rural hospital in New York State, and the following was brought to my attention. That if the provider or nurse is calling a Rx for a patient to use the E/M 99211 and the diagnosis code v68.1.
    Does anybody have any idea if this is the correct way of doing this, or has anybody tried this and it did it work? We would like to know if this is even correct way to handle this.

  2. #2
    Default 99211
    A 99211 requires face-to-face contact.

    Review the following article by AAFP concerning when a 99211 can be billed
    Heather Winters, CPC, CFPC

  3. #3
    You may get paid for it but it is not correct. There are telephone codes for non-physician services, 98966-98968, but I don't think that is the service your nurses are providing. It could be something to look into.

    I really like link that Heather posted.

    Laura, CPC, CEMC

  4. #4
    Columbia, MO
    FYI the 98966-98968 are for when the patient calls the office and speaks with nonphysician personnel, there is no code for office personnel or physician to call a rx to the pharmacy that is considered the cost of doing business. A 99211 is a face-to-face encounter whether it be nurse of physician. If it is nurse for prescription refills then the refill must be documented as only enough to tide the patient over till they can see the physician and may not be a full interval refill.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thanks for your suggestions!

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