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99211 specifications

  1. #1
    Default 99211 specifications
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    I have a dr questioning whether we can bill a level 1 OV when a patient just comes in for a blood draw, immunizations, EKG, UA, etc. what about when they come in for a script that the nurse must discuss with the dr first? what are the specifications for a level 1 visit?

  2. #2
    Columbia, MO
    You cannot charge a 99211 for a nurse or other qualified person to attend to a patient for services previously ordered by the physician. The reason the patient is present for the services you have mentioned is because the physician has evaluated the patient at a previous encounter and has determined the necessity for the test. There is no reason for additional assement, the services provided by the nursing staff is all a part of the test or service performed..... even vital signs. So IF a CPT or HCPC code exists for the service ordered and performed then you may NOT charge a 99211 you must use the code that fits the service provided. However if there is no code for the service then you may use a 99211. The physician must have a plan of care in the chart that shows the previous evaluation for the problem and the need for the return visit. The physician must also be present in the office area while the patient is being seen.

    Debra A. Mitchell, MSPH, CPC-H

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