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Code 99211 - We have a pt

  1. Default Code 99211 - We have a pt
    Medical Coding Books
    We have a pt who comes in and gets an injection of B12 (her own meds) for Herpes Zoster. Can a 99211 be billed since the phys. does not directly supervise? I know some info. I have read states this code cannot be used for just an injection. However, the CPT states that if a physician is not present to use the 99211 instead of the injection admin code 96372. I know there has been alot of discussion concerning this matter but I need a little more. Is there a definite answer?

  2. #2
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    I would just bill the injection code, but I would check with another coder in your office to be sure, is you can.

  3. #3
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    Correct me if I am wrong, to those following that can answer this question.

    "Direct supervision" does not mean that the physician or nonphysician practitioner must be present in the room when the procedure is performed. It just means that the have to be in the department/building to assist if necessary.
    Vanessa Mier, CPC

  4. Default
    Quote Originally Posted by mblevins View Post
    We have a pt who comes in and gets an injection of B12 (her own meds) for Herpes Zoster. Can a 99211 be billed since the phys. does not directly supervise? I know some info. I have read states this code cannot be used for just an injection. However, the CPT states that if a physician is not present to use the 99211 instead of the injection admin code 96372. I know there has been alot of discussion concerning this matter but I need a little more. Is there a definite answer?
    you would bill the injection using the j3490 for the b12 at 0.01 and then 96372 for the injection. 99211 is associated with having a nurse check blood pressure or other things not schedule without physician supervision.

  5. #5
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    Funny thing about that notation in the CPT book, is that if the physician is not within the office setting you canot charge for any services delivered by ancillary staff, including the 99211.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    99211 is when a nurse adminsters injection 96372 is when the doctor adminsters injection

    I code injections ever day at my office!

  7. #7
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    Quote Originally Posted by amylis1 View Post
    99211 is when a nurse adminsters injection 96372 is when the doctor adminsters injection

    I code injections ever day at my office!
    96372 does not have to be given by the physician, only under direct supervision of the physician. This means that the physician must be ON SITE to provide assistance, if needed. It does not mean that the physician even be in the same room. If there is no physician on site, 99211 must be used.

    (96372) should not be reported for injections given without direct physician supervision. If there is no other E/M code (e.g. office visit) reported on that day and an injection is given without direct physician supervision, report a 99211. If there is already an E/M code reported on that day an injection is given without direct physician supervision, then it is not billable separate from the E/M code and is included.
    I, too, code injections daily. Hopefully this helps some.
    Vanessa Mier, CPC

  8. #8
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    I agree 96372 can be used for nurses all day long. However if there is no physician on site you cannot bill a 99211 since there is no physician to use for the surpervising/rendering provider. You cannot bill physician services in a physician office setting if only the RN is present. 99211 is a physician level, it is the level the physican is allowed to charge when ancillary personnel are the ones face to face with the patient while the physician is within the office suite area. You cannot bill an office visit for a procedure when a code already exsists for that service. The 96372 injection is a planned procedure from a previous encounter so another assessment cannot be charged.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    Medicare's guidance regarding 99211 (which is in line with Debra's statement)

    30.5

    "This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service."

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

  10. #10
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    Ok so what I did not understand is that, while no direct supervision is required for 99211, the doctor must still be on site for this to be billed?

    This brings another question to mind though. What if doctor initiates plan of treatment, says "come in bi-weekly for b-12 injection", and the patient comes in at 8 am, before the doctor arrives, for her injection? Even if we use our b-12, not the patient's, we can not bill this service whatsoever?
    Last edited by ohn0disaster; 02-10-2011 at 11:47 AM.
    Vanessa Mier, CPC

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