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Thread: CPT 99211 Please, help !!!

  1. #1

    Default CPT 99211 Please, help !!!

    AAPC: Back to School
    I need help on figuring out how to code E/M services provided WITHOUT presence of physician but for 20 min. The code says 5 and I want to bill for 20. I've tried billing 4 units, but insurance will only reimburse for one. Any idea what's the correct coding for that?
    Thank you for your help!!!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    For a 99211 you need a qulaified ancillary person carrying out physician orders from a previous encounter, and there must be a provider in the office area while the patient is there. Ov codes can never be billed with units greater than 1. what was being done and by whom?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Houston, Texas

    Wink 99211

    Do a quick search for 99211 and include AAFP and you will get all kinds of coding guidelines and worksheets for 99211. This code is know as the nurses code because it is usually used to report services performed by the nurse in the presence of an M.D., which just means that he has to be in the building like someone else had said. Without knowing more specific details I can only give a general answer. And also like the other poster mentioned E/M codes can't be charged by multiple units. If you were billing for the physician, you can use prolonged face to face codes 99354-99357 but these do not work for 99211 if it is a nurse providing the services.
    Here are a few instances where you can code for a 99211; At an office visit for a urine infection the MD orders a follow-up u/a after the course of medication to see that the infection has cleared. The patient comes back to the office and does the follow-up u/a and it is negative so there is no reason to see the MD. the nurse takes the chart to the MD and gets his signature or initials on the encounter form and the patient is released. Also, follow-up glucose tests, routine protime checks and medication reviews are covered as long as the MD is there and signs off on the encounter form.

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