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99211 coding

  1. Default 99211 coding
    Exam Training Packages
    Are there certain documentation requirements for 99211 coding. In this clinic our nurses do alot of lab draws, shots, etc w/o the pt seeing the doctor. All they document is what they did and the DX so I can bill. Can I also add on the 99211 and if so is it treated the same as the other level visits and copays collected, if insurance requires? EX: pt comes in for fasting lab and then sees doctor 3 days from now. Can I bill the 99211 w/ that draw? PLease Help
    Stephanie, CPC, HCS-D

  2. Default
    If the patient comes in for a procedure, ie blood draw or injection, you cannot code a 99211. However, if the patient comes in for a blood pressure check, you can.

  3. #3
    Default
    I was taught that when you charge a 99211, minimal visit, documentation of the actual evaluation and management for the patient has to be done, including History, exam and MDM, even though they will be minimal, as it is still an E&M service. There also has to be medical necessity proven in the documentation. When you code the 99211, the NIP# that you bill under, whether it is NP or Dr, that person has to be in the office suite. I was specifically taught that it can not be used for phone calls, blood draws, or injections or infusions of medications. Let's say that we have a patient who is on coumadin and comes in for an INR check and that's all, even if the last one was reviewed with them and it is decided whether or not it will be increased, decreased, or stay the same, that does not qualify in itself for the 99211 code to be charged. There has to be a Hx, Exam, MDM done. Hope this helps
    Last edited by LTibbetts; 01-21-2010 at 09:41 AM.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Chief complaint
    Per CPT there is no requirement for History, Exam or MDM for a 99211 visit. All you really need to document is the chief complaint. Per CPT, "the presenting problem is minimal" and this service "may not require the presence of a physician."

    BUT ... all procedures include a basic E/M in the RVU for the procedure. If you are giving an injection, or drawing labs you are already being paid for that basic evaluation of the patient that is necessary for that procedure. So you should NOT be coding 99211 or any other E/M service, UNLESS you have a significant, separately identifiable E/M

    Example: Patient comes in for flu shot. Also mentions/complains of rash on ankle. The evaluation and management of the rash is a significant separately identifiable E/M from the basic evaluation that would be done before/after giving the injection. You would code that E/M and append a -25 modifier.

    Example: Patient comes in for flu shot. Nurse takes vitals and checks for history of allergic reactions. This is NOT a significant, separately identifiable E/M from the procedure. Payment for this basic evaluation is already included in the payment for the procedure. NO E/M service should be coded.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-21-2010 at 12:58 PM.

  5. #5
    Default
    Quote Originally Posted by FTessaBartels View Post
    Per CPT there is no requirement for History, Exam or MDM for a 99211 visit. All you really need to document is the chief complaint. Per CPT, "the presenting problem is minimal" and this service "may not require the presence of a physician."

    BUT ... all procedures include a basic E/M in the RVU for the procedure. If you are giving an injection, or drawing labs you are already being paid for that basic evaluation of the patient that is necessary for that procedure. So you should NOT be coding 99211 or any other E/M service, UNLESS you have a significant, separately identifiable E/M

    Example: Patient comes in for joint injection. Also mentions/complains of cough and rhinnorhea. The evaluation and management of the cough & rhinnorhea is a significant separately identifiable E/M from the basic evaluation that would be done before/after giving the injection. You would code that E/M and append a -25 modifier.

    Example: Patient comes in for joint injection. Nurse takes vitals and checks previous injection site for any signs of infection or reaction. This is NOT a significant, separately identifiable E/M from the procedure. Payment for this basic evaluation is already included in the payment for the procedure. NO E/M service should be coded.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

    Does that mean that the requirements that I was taught are for CMS only? That makes a pretty big difference in the code you choose for those visits. Obviously, I still have so much to learn about E&M, so much! I am trying to get everything straight for my CEDC test. Tessa, When they ask this stuff on the test, which payors will they be referring to? Do they tell you or are you suppose to just go with commercial payors?
    Last edited by LTibbetts; 01-21-2010 at 01:06 PM.

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default 99211
    Leslie,

    You wrote: I was taught that when you charge a 99211, minimal visit, documentation of the actual evaluation and management for the patient has to be done, including History, exam and MDM, even though they will be minimal, as it is still an E&M service.

    Look at CPT under 99212 - requires two out of three: PF history, PF exam, Straightforward MDM. These are all the MINIMAL levels.

    Look at CPT under 99211 - there is no requirement for levels of history, exam or MDM.


    "Patient here with a cold. No follow-up needed." That's a 99211 visit in my book.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  7. #7
    Default
    It does help, thanks. Maybe you're right and I'll just stick with ER coding...

  8. Default
    Hello Tessa,
    I have a puzzled question. Why would it be inappropriate to code a 99212 with a 11721 and 110.1 if the doctor did a mild debridgement of mycotic nails x 7 on a pt. that returned to the clinic. The Exam said her pedal pulses are palpable bilaterally. Why would a 99212 be inappropriate?
    Last edited by collierdh; 03-08-2010 at 01:22 PM.

  9. Default 99212 with flu shot
    It has always been clear if a patent comes in and flu shot only is given we do not bill and E/M... I am now at a new facility and i came across 400 charges were the physician billed a 99212 with flu shot. I reviewed the note and there is nothing significantly different in this note that warrants the E/M. They feel since the physician came in and took vitals and asked if the patient was allergic to eggs this warrant the E/M.

    Please can someone give me something to show them they are wrong!

  10. #10
    Location
    Salt Lake North
    Posts
    639
    Smile brooke79 this link will help
    http://compliance.med.ufl.edu/compli...of-99211-code/

    Your scenario was that your doc wants to bill 99211 simply because the doc asks the patient if they are allergic to eggs and so forth before a vaccine. This is wrong on many different levels.

    99211 does not require the physician treat the patient. Examples would be bandage changes, BP checks for patients with hypertension or being watched for it.

    A vaccine has two parts: (or any injection)

    Admin code
    Vaccine (in this case) or Rx that is given such as B12 for PA

    In order to bill the admin/vaccine + any E/M, the E/M has to be "significantly separate" from the vaccine/injection. Since your doc is asking if the patient is allergic to eggs, it's not significant nor separate. If the physician treats a medical condition totally unrelated to the injection or vaccine, then you could bill an E/M with the -25 and get payment.

    The link above describes this well. I have found this info on CMS and several other locations. This is a common situation that RAC auditors look for because they know so many physicians do it. Keep your doc safe: unless they treat a medical condition that has nothing to do with the injection services, don't bill the 99211.

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