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Thread: 99211 - I am OM for a very busy pediatric

  1. #1

    Exclamation 99211 - I am OM for a very busy pediatric

    AAPC: Back to School
    I am OM for a very busy pediatric practice in Washington, Missouri. Our physician for a large number of years, has charged a 99211 for a parent calling in to refill a controlled substance medication for ADD/ADHD. The call is noted in the patients chart and sent to the physician for revie. The physician opens patients chart and reviews the medication, dosage and last refill. then he/she writes/prints out the presciption on watermark paper and signs. This is taken to front office for parent to pickup and at that time we prove identity of parent, scan isnurance card and give the parent a questionaire to complete prior to hqanding them the script. The nurse is the one that gives script to parent and reviews the answers that the parent has given to our questionaire. If patient is having any problems then we make appointment for patient to be seen by physician. if patient is doing fine on medication and soage then we make sure that the patient has made an appointment within 4 months from his/her last.. then nurse puts note in patient chart and sends to physician to see and review and sign off on.

    I have had numerous chart audits and not once told not to or we cannot bill for this.

    ? is can we charge a 99211? If so do we collect a copay?
    Last edited by ank3t; 10-20-2016 at 04:29 AM.

  2. #2

    Smile 99211-Medication refill


    Question:I often see patients for a follow-up of chronic medical problems after I authorize a single refill of their medications over the phone – just enough so that they do not run out before the visit. I review patients' me0dication lists prior to authorizing these refills. Can this work influence the level of service of the subsequent office visit, or do I have to repeat the review?

    Answer: E/M services are valued to include certain pre- service and post-service work. The Centers for Medicare & Medicaid Services has defined pre-service work as preparing to see a patient, reviewing records and communicating with other professionals when appropriate. Post-service work includes coordination of care, documentation and telephone calls with the patient, family members or other health professionals associated with the delivery of care to the patient (excluding separately billable services, such as care plan oversight).

    A medication refill is generally part of the post-service work, regardless of the amount of time lapsed. However, reviewing the patient's medications counts as evaluating the patient's past history. According to Medicare's Documentation Guidelines for Evaluation and Management Services, one of the requirements of a detailed history is that the pertinent past, family or social history be reviewed. If the chart note that was produced at the time of the refill indicates that you reviewed the patient's medications, you can simply document the date of that prior note, e.g., “Medication list reviewed on 2/1/07 with refill request.”

    Also, your decision to continue current medications based on the results of this encounter should be documented and included when you calculate the medical decision making. Prescription drug management is associated with a moderate level of risk, which may influence the level of medical decision making.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    a 99211 cannot be charged for phone calls at all. If the call is initiated by the patient then the physician can charge a phone encounter 99441-99444 but only for the amount of time he on the phone. However you can charge a 99211 when the parent comes in to pick up the medication and talks with the nurse as long as the nurse documents the encounter and the physician is within the office suite at the time.

    Debra A. Mitchell, MSPH, CPC-H

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