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Can you bill a 99211 with a UA?

  1. #1
    Salt Lake North
    Cool Can you bill a 99211 with a UA?
    Exam Training Packages
    Patient comes in for a UA only due to UTI. Never sees the doc. I know we can bill the 81002 for the UA but can we bill the 99211 or just the UA? Thanks for your help.

  2. #2
    Default It depends.
    I would say that depends on whether or not you have documentation that the patient saw a nurse or MA.

    99211 is MD-not-required lasting less than 5 minutes so there doesn't have to be a lot to the documentation, but there has to be proof of a face-to-face with someone.

    To clarify, yes, I agree it has to be other than performing the dip/reagent. That's what I meant by "saw" the nurse or MA. Presumably, the nurse would document the patient's current complaint and discuss the case with the MD and they would develop a treatment plan or not if it isn't warranted. Then the 99211 is perfectly legitimate.
    Last edited by Belinda Frisch; 06-10-2010 at 05:24 PM. Reason: Clarification

  3. Default
    Does the documentation support a separate service above and beyond the work already performed and captured as 81002.

    If so, then code 99211-25. If not, code 81002 only

  4. #4
    Evansville Indiana
    Default 99211
    Remember you would have to meet "incident to" guidelines. A UTI is an acute problem which cannot be billed as "incident to".

  5. Default
    I agree with cheermom, but unless the patient self-diagnosed, she/he is probably coming in due to a symptom ie urinary pain. The DX of UTI would have to be established by the Doc

    I was reading the question as "come in for a urine test. If it shows clear, then you will see the Doc to DX the problem. If it shows abnormal, then you will see the Doc for DX and treatment". Which is why I suggested the presenting problem was a symptom and not a DX

  6. #6
    Default Modifier-25
    Suppose if received documentation supports with both these codes in this senario, then its appropriate to append modifier-25 with 99211 CPT code?

    Quote Originally Posted by sbicknell View Post
    Does the documentation support a separate service above and beyond the work already performed and captured as 81002.

    If so, then code 99211-25. If not, code 81002 only

  7. #7
    Columbia, MO
    If the patient comes into the office expressing symptoms and the nurse does the ua, but the physician does not see the patient then a 99211 may not be billed at all. You may bill for the UA. This cannot be a 99211 from a nurse or physician standpoint. The physician has not evaluated the patient to establish a plan of care for this dx so therefore it cannot be incident to and the physician does not see the patient face to face so it is not a physician encounter.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default Some resources and their position on the UA example
    An established patient comes to the office with complaints of urinary burning and frequency. The nurse takes a focused history, reviews the medical record, discusses the situation with the physician and orders a urinalysis. The nurse then presents the findings to the physician, who writes a prescription for an antibiotic. The nurse communicates the instructions to the patient and documents the encounter in the medical record. In this example, 99211 and the appropriate laboratory code for the urinalysis should be reported because the E/M service is distinct from the lab service and appropriate for the evaluation of the patient's complaint.

  9. #9
    Columbia, MO
    I disagree the physician must see the patient face to face before a physician level can be charged. The nurse cannot render the dx to the patient. A decision health articel from 2002 Feb 11 which was written by Kathleen Mueller the compliance officer for CMS discussed this exact scenario. There is no plan of care for the nurse to be following so it does not meet incident to criteria. It is not a shared encounter as the physician does not see the patient face to face and write his assessment. There is no basis for a physician visit level, and a 99211 is a physician visit level there are no visit levels for nurses.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default Judgment Call...
    I'd say this is one of those "hot" topics and a judgment call on the part of the physician and the coder. Payers may handle it differently and if this isn't a Medicare patient, I'd take it in to consideration.

    There are certainly sources to cite to support you in billing it (including the AAFP) and I don't think anyone is going to suffer any major consequences for a $10-ish nurse visit billed in good faith. Even if more than once.

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