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Thread: procedure codes 99211, 36416, 85610-QW ?

  1. #1

    Talking procedure codes 99211, 36416, 85610-QW ?

    AAPC: Back to School
    Is a e/m code 99211 billable and payable with 36416 venipuncture, 85610-QW protime?


  2. #2
    Join Date
    Apr 2007

    Unhappy pro-times

    i'm having the exact same problem. the ma's in the office do the pro-time & they insist that we can bill a level 1 e/m. they say they are providing education. EVERY claim submitted with 99211, 36416, 85610 is being denied.
    SOMEONE PLEASE HELP!! I need something in black & white to let them know how to do this. The ma's have the doctors convinced this is appropriate to get more money for the visit.

  3. #3
    Join Date
    Apr 2007
    Lauderdale Lakes


    Here's an article that might help


  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Here is an excerpt from a recent publication regarding the OIG focus for 2012 on incident to and 99211 encounters:
    CPT® Definition of 99211:

    "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services." (CPT® 2010)

    Criteria for billing 99211 Incident-to:

    Must be an established patient
    There must be an established plan of care
    There must be an E/M service provided by an employee of the physician
    Must be provided in the office
    There must be direct physician supervision

    Code 99211 should not be used if the sole purpose is:

    Giving the patient an injection
    Drawing blood, venipuncture (*INR/Coumadin clinic*)
    Writing a prescription renewal
    Making telephone calls

    Also just to clarify a venipuncture is 36415, a fingerstick is 36416

    Debra A. Mitchell, MSPH, CPC-H

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