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Please help w/ coding question

  1. Angry Please help w/ coding question
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    MY PHYSICIAN IS SEEING PATIENTS AT ANOTHER INFERTILITY CENTER. I AM BILLING FOR HER VISITS AND ANY PROCEDURES SHE DOES.

    THE CENTER EMPLOYS AN INDIVIDUAL WHO WAS A MEDICAL PHYSICIAN IN RUSSIA, AND IS A CERTIFIED ULTRASONOGRAPHER WITH OVER 10 YEARS EXPERIENCE IN THIS FIELD.
    SHE IS THE IVF CO-ORDINATOR FOR THIS CENTER. DR J MONITORS THESE PATIENT'S CYCLES WITH BLOOD & ULTRASOUND RESULTS. IF THEY NEED INTRA UTERINE INSEMINATIONS SHE TELLS THE CO-ORDINATOR WHEN TO DO THE IUI. DR J. IS NOT AT THIS SITE WHEN THIS OCCURS.

    THE CENTER IS REQUESTING THAT WE BILL INSURANCE FOR THE PERCOLL SPERM WASH AND INSEMINATION, WHEN DR J. WAS NOT ACTUALLY THERE. CURRENTLY, I ONLY BILL FOR A MINIMAL SERVICE 99211 WHICH COMPENSATES HER FOR THE MONITORING MANAGEMENT/ DECISION MAKING FOR THESE PATIENTS.

    I WOULD APPRECIATE ANY HELP YOU CAN GIVE ME, OR REFERENCES I CAN USE TO MAKE AN INFORMED DECISION ON THIS MATTER.

    THANK YOU

    HALINA
    ivfrj@aol.com

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    If the physician is not on site then you cannot bill a 99211 for any other person to see patients and bill under your physician number.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Durham, NC
    Posts
    13
    Default
    When to Use 99211
    The patient must be established – an established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years.
    The Provider-patient encounter must be face-to-face – telephone calls with patients do not meet the requirements for reporting 99211.
    An E/M service must be provided – this means that the patient’s history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported.
    Example 1 – 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
    Example 2 – if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician could report CPT code 36415 (venipuncture) instead of 99211.
    The service must be separate from other services performed on the same day. Services that are considered part of another E/M service provided on the same day should not be reported with code 99211:
    If a nurse provides instructions following a physician’s minor procedure or takes a patient’s vital signs prior to an encounter with the physician, 99211 should not be reported for these activities because they are considered part of the E/M service already being provided by the physician.
    The presence of a physician is not always required – Although physicians can report 99211, CPT’s intent with the code is to provide a mechanism to report services rendered by other individuals in the practice (such as a nurse or other clinical staff member). According to CPT, the staff member may communicate with the physician , but direct intervention by the physician is not required.

  4. #4
    Location
    Durham, NC
    Posts
    13
    Smile
    When to Use 99211
    The patient must be established – an established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years.
    The Provider-patient encounter must be face-to-face – telephone calls with patients do not meet the requirements for reporting 99211.
    An E/M service must be provided – this means that the patient's history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported.
    Example 1 – 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
    Example 2 – if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician could report CPT code 36415 (venipuncture) instead of 99211.
    The service must be separate from other services performed on the same day. Services that are considered part of another E/M service provided on the same day should not be reported with code 99211:
    If a nurse provides instructions following a physician's minor procedure or takes a patient's vital signs prior to an encounter with the physician, 99211 should not be reported for these activities because they are considered part of the E/M service already being provided by the physician.
    The presence of a physician is not always required – Although physicians can report 99211, CPT's intent with the code is to provide a mechanism to report services rendered by other individuals in the practice (such as a nurse or other clinical staff member). According to CPT, the staff member may communicate with the physician , but direct intervention by the physician is not required.

  5. #5
    Default
    THE CENTER IS REQUESTING THAT WE BILL INSURANCE FOR THE PERCOLL SPERM WASH AND INSEMINATION, WHEN DR J. WAS NOT ACTUALLY THERE.............


    I can't stress this strongly enough.......No NO NO NO NO

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