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View Poll Results: To add 99211-25 or not to add...

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  • 99211-25, J3120x2, 96372

    2 20.00%
  • J3120x2, 96372

    7 70.00%
  • something else, see my reply

    1 10.00%
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Thread: Would I add the 99211-25 to the visit? Why or why not?

  1. #11
    Join Date
    Apr 2007
    Columbia, MO


    AAPC: Back to School
    Quote Originally Posted by cmontgomery View Post
    Regarding the 99211, Novitas is telling us to add a mod25 to the 99211 when we bill it out with a 85610QW and 36415. We bill out 99211-25 with the main diagnosis for the protime and the 85610-QW and 36415 with the v58.61 long time use of anticoagulants. We originally billed out under the v58.61 a 99211, 85610QW and 36415-59 until they stopped paying for the 99211. When we called they said the 99211 needed a mod25. How would you bill this out then?
    You would drop the 99211. If the patient presents for a pro time you bill only the blood collection and the lab code.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
    Join Date
    Apr 2007
    Fort Wayne


    Quote Originally Posted by mitchellde View Post
    You do not use a 99211 to give an injection, and the previous post that indicated that injection admin and 99211 are interchangeable is incorrect. These are not interchangeable. If the reason for the encounter is to receive a planned injection then you use injection admin and the drug only never a 99211 you do not have a separately identifiable encounter, you have only the encounter necessary for the injection. Many do code the B12 using a 99211 when they do not have the medical necessity for Medicare to pay for the B12. This is absolutely incorrect.
    I am going to disagree with this statement. In the CPT book under 96372 it states that you cannot bill 96372 without direct supervision. To report, use 99211. If you are giving a planned injection and supervision is present, it would be 96372 but if the physician is not present, it states to bill 99211.

    However, to bill 99211 for most insurance companies you must meet incident-to guidelines, one of which is direct supervision. You have to be very careful, but some insurance companies may still allow it and it does follow CPT guidelines.

  3. #13


    My office does frequent self inj teaching for testosterone. We bill and E/M plus the medication. Is there a code for the teaching since we cant bill for the inj since the pt is physically doing this themselves? I have been looking into 98960. Is this correct?

  4. #14
    Join Date
    Apr 2007
    Columbia, MO


    You cannot bill a 99211 in a physician office setting unless the provider is in the office. 99211 is a provider level that can be used when qualified ancillary staff are with the patient executing physician orders from a previous encounter. This must be done with a physician on site. You must use an NPI in field 24j for the supervising/rendering provider. If the provider is not on site, they can be neither supervising nor rendering.

    Debra A. Mitchell, MSPH, CPC-H

  5. #15


    The provider would come in and review labs or discuss other concerns with the pt, then the mid level or MA would come in to do the teaching. Can I bill 98960 for the inj teaching?

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