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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Would I add the 99211-25 to the visit? Why or why not?

  1. #1
    Default Would I add the 99211-25 to the visit? Why or why not?
    Medical Coding Books
    My question is: Would I add the 99211-25 to the visit? Why or why not?

    An RN administered 200mg Testosterone IM for a standing order.

    In the CPT book it gives these Clinical Examples:

    Office visit for an 82-year-old female, established patient, for a monthly B12 injection with documented Vitamin B12 deficiency. (Geriatrics/Internal Medicine/Family Medicine)

    Office visit for a 50-year-old female, established patient, seen for her gold injection by the nurse. (Rheumatology)

    I looked up some similar coding situations and there is contradictory advice to using the99211-25 or not. Please give me some feedback and reasons why

    Thanks in advance!!
    Heidi Thompson, CPC

  2. #2
    Default
    Quote Originally Posted by hthompson View Post
    My question is: Would I add the 99211-25 to the visit? Why or why not?

    An RN administered 200mg Testosterone IM for a standing order.

    In the CPT book it gives these Clinical Examples:

    Office visit for an 82-year-old female, established patient, for a monthly B12 injection with documented Vitamin B12 deficiency. (Geriatrics/Internal Medicine/Family Medicine)

    Office visit for a 50-year-old female, established patient, seen for her gold injection by the nurse. (Rheumatology)

    I looked up some similar coding situations and there is contradictory advice to using the99211-25 or not. Please give me some feedback and reasons why

    Thanks in advance!!
    'Never' isn't a word I like to use often, but you will never add 99211/25 to a visit. The reason is, in order to use the 25 modifier, the E/M has to be significant/separately identifiable. 99211, by definiton, doesn't meet those requirements. Under the code descriptor is states: "Usually, the presenting problem(s) are minimal." There are no key components for this service, so it cannot be considered significant or separately identifable from the usual pre-service and post-service work typically associated with procedures, or from other E/M services. If you don't have enough for at least a 99212, you don't bill a separate E/M. Hope that helps!

  3. #3
    Default
    Thank you for your response.

    I have been coding the J code with 96372 and not allowing the 99211; however, I wanted to check the clinical examples of when would a 99211 be appropriate and it listed the examples that I posted as well as:
    Office visit for a 73-year-old female, established patient, with pernicious anemia for weekly B12 injection. (Gastroenterology)

    My next question would be: How would you code the examples shown in the book if you can bill a 99211 for a nursing visit, but not be able to be reimbursed if you did it correctly per their example?

    I would code the above visit as 96372, J3420 for 281.0. The way it's written since it's a clinical example is 99211, 96372, J3420 for 281.0

    It would be denied as inclusive in visit as written, so why would/wouldn't you add the -25. Those 3 examples are contradictory to reality, aren't they?

    I think I'm playing devil's advocate because I want to be able to have an answer if Billing comes back to me with the question of why didn't I add those. I internally feel like it doesn't belong, but I needed some feedback for my comfort
    Last edited by hthompson; 04-25-2011 at 01:56 PM. Reason: Added a thought...
    Heidi Thompson, CPC

  4. #4
    Default
    Quote Originally Posted by hthompson View Post
    Thank you for your response.

    I have been coding the J code with 96372 and not allowing the 99211; however, I wanted to check the clinical examples of when would a 99211 be appropriate and it listed the examples that I posted as well as:
    Office visit for a 73-year-old female, established patient, with pernicious anemia for weekly B12 injection. (Gastroenterology)

    My next question would be: How would you code the examples shown in the book if you can bill a 99211 for a nursing visit, but not be able to be reimbursed if you did it correctly per their example?

    I would code the above visit as 96372, J3420 for 281.0. The way it's written since it's a clinical example is 99211, 96372, J3420 for 281.0

    It would be denied as inclusive in visit as written, so why would/wouldn't you add the -25. Those 3 examples are contradictory to reality, aren't they?

    I think I'm playing devil's advocate because I want to be able to have an answer if Billing comes back to me with the question of why didn't I add those. I internally feel like it doesn't belong, but I needed some feedback for my comfort
    The clinical example you're referring to would apply, if you did not bill the administration code for the injection - 99211 and 96372 can actually be used interchangeably to describe an injection administered by a nurse (see the parenthetical notes under 96372). Normally, I'd say to bill whichever has the higher reimbursement, if a physician rendered the services, but for B-12 injections, I'd use 99211 instead of 96372, because B-12 injections are rarely covered by insurers, and when the J-code denies, it drags the administration code down with it. Since 99211 isn't technically an admin code, in theory, it wouldn't be denied just because J3420 is.

  5. #5
    Default One more thing...
    96372 and 99211 are on the NCCI edit tables (Column I/Column II)
    Column I / ColumnII / Effective Date / Status Indicator
    96372/ 99211/ 20090101/ * 0


    The status of "0" means that no modifier can override the edit.

  6. #6
    Default LAST ONE, I promise!!!
    If you need something more authoritative to back up your stance, use this:
    http://www.cms.gov/MLNMattersArticle...ads/MM4032.pdf

  7. #7
    Default
    Thanks! I printed it and I called Billing with the information!

    You rock, Brandi!
    Heidi Thompson, CPC

  8. #8
    Default 99211 and 96372
    I was hoping to get clarification on the use of 99211 and 96372. Our FNP had used the codes 99211, 96372 and J1080 to bill for testosterone injections with a diagnosis code of 780.71.

    The 99211 nurse note only indicates that she is providing a testosterone injection and I feel that she should have only coded 96372 and J1080. Is this correct?

    I did review http://www.cms.gov/MLNMattersArticle...ads/MM4032.pdf for some additional information and it states not to allow payment for 99211 if billed with a drug administration service, expanded to include therapeutic and diagnostic injection codes.

    Thank you for the help

  9. #9
    Location
    Columbia, MO
    Posts
    12,531
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    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?

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