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99211

  1. #1
    Default 99211
    Medical Coding Books
    99211 should not be listed with a procedure code, correct?

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    probably not...
    could you elaborate on the issue at hand? what exactly was done?
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Default
    My problem is at my facility certain doctors put these procedures at a nurses level repeatedly. Ex 10160 with a 99201/25
    46083 " " 99201/25
    10060 with a 99211/25
    29580 with a 99211/25

    So this should not be these levels right?

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Well, to simply say "no" would be wrong - it depends on the documentation. That being said, if the reason for the visit is for the procedure, nothing else- then yes - I'd only be coding the procedure because the exam of the effected area is included in the procedure code. (you can't just do a procedure without first looking at the issue).

    I have a feeling that these services are just procedures and shouldn't be coded with an E/M. But I couldn't say for postive without seeing a note.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. #5
    Default
    Quote Originally Posted by scharette View Post
    My problem is at my facility certain doctors put these procedures at a nurses level repeatedly. Ex 10160 with a 99201/25
    46083 " " 99201/25
    10060 with a 99211/25
    29580 with a 99211/25

    So this should not be these levels right?

    Well - in order to bill for a procedure and E/M on the same day, the E/M must be significant and separately identifiable.

    99201 requires the presense of the physician. So no, they cannot use this code at all if the doctor doesn't see the patient.

    Are the patients scheduled to have these procedures done? Example: Dr. Jones saw Jane yesterday advised to come back for I&D. Nurse does I&D on day 2. In this case, only the procedure should be billed.

    If the procedure is done the same day the physician is doing the E/M, you should use modifier 25 on the E/M - again, as long as it's significant and separately indentifable. But the doctor can't bill his visit, the procedure and nurse visit all on the same day.

    If something is that significant enough to warrant an E/M at the time the nurse is doing the procedure...the physician should probably get involved anyway.

    Hope this helps.

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