# teaching visit 99211



## Lmurf (May 23, 2010)

Hi
We have knowledgeable staff member in our office for years who instructs patients how to take their humira or hepatitis injections. Sometimes she is with the patient for almost an hour answering their questions.  Since she is not a nurse and has no certification as a medical assistant, can we still bill for a 99211 visit for these teachings.  Any guidance you can give would be appreciated.
Thanks in advance
Lin


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## sbicknell (May 23, 2010)

Let me play this out in a scenario.  You say this person is not a nurse, tech or any type of certified medical staff

So let's say it's one of your billing staff, who since she has been with the practice for years, has picked up an understanding of these services. 
1) no you can not bill a 99211
2) how would this be documented in the chart? "Lead biller educated the patient on how to do his hepatitis injections"
3) as a patient, I would expect care from a health professional, not a insurance biller regardless of how "knowledgeable" she is

I would be interested in other's thoughts on this question


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## mitchellde (May 23, 2010)

A 99211 can be billed for any ancillary personnel as long as they are competent to perform the activity ordered by the physician and the physician is on site.  The basic incident to provision.  While it is not restricted to nurses per se, I am curious as to this "knowledgeable staff" person.  If they are not a nurse or a certified medical assistant then how are they capable of teaching a patient how to administer an injection?  Is this person certified in any way, and allowed to give injections herself?  If not then in no way can they do teaching and have it billed as a 99211.


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## Lmurf (May 24, 2010)

She has assisted in the office for over 25 years but does not have any certification as an aide.  So technically she is not a medical assistant.   She has had training from doc and is very knowledgeable but no certification.  In Medicare Part b newsletter from The coding institute May 2010 it states "Any qualified personnel who are employees of the physician can report 99211--so long as hey are working under he physicians direct supervision.  Examples include registered nurses, licensed practical nurses and other ancillary staff who have training o provide an E/M visit. " MY OM had asked me if they could bill for teaching but I wasn't sure as she doesn't have any certification.


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## Jagadish (May 24, 2010)

99211 can be billed only by any qualified NPP or Physician. The above services cannot be billed with 99211


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## mitchellde (May 24, 2010)

Jagadish said:


> 99211 can be billed only by any qualified NPP or Physician. The above services cannot be billed with 99211



No not true it is correct that any QUALIFIED health care person in the office that is providing services prescribed by the physician which cannot be coded with any other code may have that encounter coded with a 99211.  My concern was if this person can be deemed qualified to teach the proper method of giving self injections.


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## Lmurf (May 24, 2010)

okay so could a person with 25 years experience and no certification be deemed qualified or do they really need that certification   any comment


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## mitchellde (May 24, 2010)

If you want my opinion I feel a certification for what you are describing is necessary.  But I do not know if it is required.


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## sbicknell (May 24, 2010)

If it is the plan to have the front office staff (non-clinical) provide patient education and bill a 99211 under the Physician's name, I would for sure document the heck out of the specialized education and training this person has received that supports her as qualified to provide this patient care. I would keep it on file for the upcoming lawsuits. I find it hard to believe a physician would open himself up to this. 

And again, as a patient, I don't want my medical care and education provided by the same person who makes my appts or bills my insurance. And since usual front office staff are not authorized to document clinical care in the patient's record, how is this patient education being documented in the record?  Are we back to the physician documenting “my front desk clerk educated the patient on how to self-administer medication injections.”

Send this person for education and certification. If she has been with the office for 25 years, she has more than earned this. If not, then have the nurse provide the patient education 

And if the patient saw the Physician that day and then the patient is educated on self-administration based on his order, the education service is considered an extension of the physician visit and you can't code 99211 anyway.


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## Jagadish (May 26, 2010)

The following answers lot of questions on billing 99211 to medicare:

http://www.trailblazerhealth.com/Publications/Job Aid/DocReqCPT99211JobAid.pdf


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## Jagadish (May 26, 2010)

The following answers lot of questions on billing 99211 to medicare:

http://www.trailblazerhealth.com/Publications/Job Aid/DocReqCPT99211JobAid.pdf


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## Lmurf (May 27, 2010)

thanks for the article and your responses


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