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Dip UA and 99211?

  1. #1
    Location
    Pottstown/Philadelphia
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    266
    Default Dip UA and 99211?
    Medical Coding Books
    If the pt sees the nurse for a dip UA and gets the diagnosis and the dr writes a script and is counseled by the dr can we charge a 99211? I say yes but our drs want to see it in writing and the only place I can find legitimate support is in reference to immunizations/pediatrics. Does anyone have a better or other source?

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    you may not charge a 99211 as a nurse visit in this circumstane. The physician must have already examined the patient in a prior encounter and have the plan docuemnted for a return visit and must be present in the office. SO the patient has not been examined by the physician and ordered a follow up encounter. Ig the physician sees the patient in a face to face then he must document his own exam and can bill then what ever level his documentation supports. Signing off on the nurse documentation is not sufficient to bill any level. You may not bill a 99211 to administer injections either.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default Confused
    I am confused as why it cannot be billed as a 99211. The nurse saw the pt and did the dip and diagnosed and dr wrote the rx. why wouldnt this count as incident-to?

  4. #4
    Default
    You can't be incident to on a new problem.

    If the doctor sees the patient they should have a note and you should at least have a 99212.

    I agree with Debra on this one, in fact I just had to remove a 99211 from our billing system for the same scenario.


    Laura, CPC, CEMC

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by jifnif View Post
    I am confused as why it cannot be billed as a 99211. The nurse saw the pt and did the dip and diagnosed and dr wrote the rx. why wouldnt this count as incident-to?
    Also a nursing credential does not give a nurse the ability to render a dx to a patient . That can be done only by a physician.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    Pottstown/Philadelphia
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    266
    Default
    Okay, I am understanding. I guess my confusion comes from the trailblazers site that states the criteria for billing a 99211. I don't see where it says the pt has to be seen prior to the visit.
    from trailblazers/cms:
    Code 99211 requires a face-to-face patient encounter; however, when billed as an “incident to” service, the physician's service may be performed by ancillary staff and billed as if the physician personally performed the service. For such instances, all billing and payment requirements for “incident to” services must be met.
    As with all services billed to Medicare, code 99211 services must be reasonable and necessary for the diagnosis or treatment of an illness or injury. Unlike the other E/M CPT codes, the CPT book does not specify completion of particular levels of work for code 99211 in terms of key components or contributory factors. Also, unlike the other E/M codes, CMS did not provide documentation requirements for code 99211 in the “E/M Documentation Guidelines.”
    CPT code 99211 describes a service that is a face-to-face encounter with a patient consisting of elements of both evaluation and management. The evaluation portion of code 99211 is substantiated when the record includes documentation of a clinically relevant and necessary exchange of information (historical information and/or physical data) between the provider and the patient. The management portion of code 99211 is substantiated when the record demonstrates influence by the service of patient care (medical decision-making, provision of patient education, etc.). Documentation of all code 99211 services must be legible and include the identity and credentials of the individual who provided the service.
    forgive me, i am new to family practice.

  7. #7
    Default
    The reason a nurse visit can't be charged in this case is not because it doesn't meet the criteria for 99211, but rather because it doesn't meet the criteria for "incident-to".
    Walker Bachman, CPC, CPPM

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Walker 22 is correct. In your statement from trailblazers you state"For such instances, all billing and payment requirements for “incident to” services must be met." Incident to requirements state the physician must first examine the patient for the same dx and have a plan of care that includes this visit as a follow up. And the physician must be present in the office. That is per Medicare section 2050.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    An example of 99211 being used correctly is when the provider sees a patient with htn and makes med change. The patient is told to return for bp check by the nurse. Pt returns, nurse takes bp and reviews with provider. Pt is instructed to either continue with same meds or med change is made. This would be correctly coded as 99211.

    Meg, CPC

  10. #10
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default Still having office issues!
    Sorry to bring up this dead horse again, but.....a dr from our office insists on billing for this scenario due to an article from aafp: http://www.aafp.org/fpm/2004/0600/p32.html

    The article states as an example: An established pt comes in c/o urinary burning and frequency. Nurse takes history, reviews med record, discusses situatin w/ dr and orders ua. nurse presents findings to dr who writes an rx for an antiobiotic. nurse gives instructions to pt and documents encounter. per the article this is okay to bill the 99211.

    From what everyone has told me that is not appropriate b/c it is a new problem. Well, I have trouble with the drs to begin with b/c they don't want to listen to a coder. Then I tell them they can not bill for the 99211 in the above situation and now they find the exact situation on aafp and say they are going to bill for it.

    Sorry, but who is correct here. I am the only coder in a billing company for 12 practices and have no voice. I give up the information and they fight it anyway. If it is not medicare, does this mean they can bill for it? I really am so frustrated so please bare w/ me. Thanks to everyone!

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