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99211 bill the patient?

  1. #1
    Default 99211 bill the patient?
    Medical Coding Books
    Hello everyone,
    This patient insisted to come to the office to get her blood pressure check, the Dr. try to explained the patient that if she only come for a bp check this was going to be a unnecesary office visit charge (co-pay) because patient had an appoitment already set to see her. Because patient insisted Dr. took the patient pressure, however on the Dr. notes she did not documented enough to bill a 99211 to Medicare. Dr. is furious and is asking me if we can bill the patient. Should I bill the patient or not?

    Thanks to all for your response on advance!
    Mildred Nieves, CPC

  2. #2
    Location
    Evansville Indiana
    Posts
    451
    Default 99211
    No, you cannot bill the patient. I am curious why they just didn't have the nurse do a courtesy blood pressure???

    LeeAnn

  3. #3
    Default
    LeeAnn I totally agree with you I ask myself the same question,
    thanks for your reply
    Mildred Nieves, CPC

  4. #4
    Default
    Just curious... what did the Doctor document... 99211 is typically a 5 min visit... even if you code based on time and he spent 5 minutes with the patient and more than 2.5 minutes talking to her about her blood pressure then you should be justified in billing ins. Granted I work in pediatrics so we do not bill medicare so I cannot speak to their guidelines but from a strictly coding view that would be my opinion.
    Barbara Haskins CPC

  5. #5
    Default
    Quote Originally Posted by NIEVESM View Post
    Hello everyone,
    This patient insisted to come to the office to get her blood pressure check, the Dr. try to explained the patient that if she only come for a bp check this was going to be a unnecesary office visit charge (co-pay) because patient had an appoitment already set to see her. Because patient insisted Dr. took the patient pressure, however on the Dr. notes she did not documented enough to bill a 99211 to Medicare. Dr. is furious and is asking me if we can bill the patient. Should I bill the patient or not?

    Thanks to all for your response on advance!
    Wow....how long have you worked for this Dr.?
    You can bill it of course but more than likely mcare is going to have a problem with her next visit. Especially if it's within a few days.
    Maybe you should advise the the Dr. about frequency of visits and discuss what she would rather be pd for.
    I think most would rather have the $ for a 13 or a 14 rather than a 11.

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by NIEVESM View Post
    Hello everyone,
    This patient insisted to come to the office to get her blood pressure check, the Dr. try to explained the patient that if she only come for a bp check this was going to be a unnecesary office visit charge (co-pay) because patient had an appoitment already set to see her. Because patient insisted Dr. took the patient pressure, however on the Dr. notes she did not documented enough to bill a 99211 to Medicare. Dr. is furious and is asking me if we can bill the patient. Should I bill the patient or not?

    Thanks to all for your response on advance!
    First of all, why did the patient see the doctor and not the nurse? If the physician felt it to be a medically unnecessary visit, she should have just had her see the nurse. Physicians should not code 99211.
    Second, unless you have an ABN for that visit you cannot bill Medicare OR the patient.
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default 99211
    Are you sure that the documentation does not meet the standards for 99211? The only documentation requirement for a 99211 is a chief complaint. In this case, "F/U HTN" would be sufficient.

    While a 99211 visit doesn't usually require the services of an MD, it is perfectly acceptable for an MD to use this E/M code.

    And, no, if there is not sufficient documentation to bill Medicare (or any other carrier), then you cannot just bill the patient.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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