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Thread: Help with interpretation of 99211 description

  1. #1
    Join Date
    Apr 2007

    Default Help with interpretation of 99211 description

    AAPC: Back to School
    I am in need of your help. We have a provider who wants to start billing 99211 with all nurse visits. I have given the Medicare guidelines however he has an article from the Primary Care website that states that there does not have to be the 3 components. We would like to get everyones opinion on what is required in the documentation and also can a CMA bill for this or is it out of their scope of practice.

    Your help in this matter is greatly appreciated. Thank you so much

  2. #2


    There are no strict documentation guidelines to bill a 99211 but this can be billed by a MD, DO, and also by a PA if PA is billed under a separate billing ID.
    Jagadish, CCS-P, CPC

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    You may use the 99211 for Provider visits performed by ancillary personnel such as nurses or MAs. The visit must meet the incident-to definition, the way this is stated in the regs is the physician must show that they materially participated in the care of the patient for the same dx and has a plan of care regarding this in the chart, and the provider is required to be on site while the patient is being seen, which they defined on site as to be within the narrow confines of the defined office suite area. Feb 11 2002 Kathleen Mueller who was the compliance officer for CMS wrote an article for Decision Health regarding the usage of the 99211, and in this she states that you may not use this to charge for a blood draw encounter or for injection administration. Also CR 148 which was released in 2004 states how the claim is to be completed for these encounters, essentially in box 17 and 17b you put the name and NPI of the provider in this practice that saw this patient for this same dx and in 24J is the NPI of the supervising provider which is the signature on line 31.
    As far as requirements documentation, there are not the 3 components as there are for other encounters, either documentation that the physicians saw the pt face to face or that this was an incident to encounter by the nurse or other qualified person.
    I hope this helps.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007


    thank you so much

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