Results 1 to 3 of 3

Can a nurse code higher than 99211?

  1. #1
    Greeley, Colorado
    Question Can a nurse code higher than 99211?
    Medical Coding Books
    So - here I sit with with CPC, CPMA and CEMC certifications...darned if I can find documentation from CMS or any other sourse to support my stance that a nurse cannot code any higher than 99211 for any reason. Please help! I need to locate the written documentation to support my stance!! I have an RN telling me that she "has never heard that you can't bill higher than 99211 for a nursing visit". This is specifically for a wound care clinic where the nurse may do multiple dressing changes, discharge planning (from the wound care clinic, and/or extensive wound care education.
    I KNOW that I am right, but of course am being forced to provide documentation to support this...since I am "just a coder" (with extensive experience and multiple credentials)!!!
    Last edited by Lisa Bledsoe; 07-11-2011 at 12:42 PM. Reason: spelling
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Columbia, MO
    If you are billing outpatient facility the rules are different as it is the facility billing and not the nurse and the facility is allowed to bill for utilization of facility resources. If on the other hand this is physician office setting then only the provider may bill using office visit codes. The 99211 is a provider level it is not a nurse level, it is the level of care a provider is allowed to bill when ancillary personnel (ie nurse) is the one face to face with the patient following physician orders from a previous encounter for the same reason. The Provider is required to be within the office suite area while the patient is being seen. If your nurse is an NP then she falls under the definition of provider and may bill any visit level documented. NP, MD,DO, etc these are providers, Nurses , MAs, Techs, etc these are ancillary personnel.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Greeley, Colorado
    Thanks Debra! The facility is billing a higher level, but for the nurse employed by the physicia for which I am coding, I have told her she cannot submit higher than 99211 (for physician-based billing purposes).
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. Nurse visit 99211
    By ibtrazy2u in forum E/M
    Replies: 3
    Last Post: 07-11-2015, 09:16 AM
  2. 99211 for nurse
    By lthomas2 in forum E/M
    Replies: 3
    Last Post: 01-31-2014, 08:06 PM
  3. 99211-Nurse Visit?
    By veloso in forum E/M
    Replies: 3
    Last Post: 01-15-2013, 06:11 PM
  4. Nurse Visit 99211
    By Tricia13 in forum E/M
    Replies: 2
    Last Post: 03-07-2012, 02:38 PM
  5. 99211 and Nurse Only Clinic
    By dballard2004 in forum E/M
    Replies: 18
    Last Post: 01-19-2010, 06:23 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.