# nurse RN    99211 and 99201 coding



## npirnat (Aug 30, 2010)

I have a infectious disease specialist who is getting referrals from providers for her RN to see patients for dressing changes and wound vacs.  The provider who owns the practice has not seen the patient but wants has written standing orders for the patient.  It is my understanding that the employed RN of the practice cannot see a patient w/o the provider seeing the patient first as a patient of the practice whether new or est. Please advise. 

thanks,


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## mitchellde (Aug 30, 2010)

You are correct 99201 is a provider only level, and 99211 can be use by the provider when a qualified ancillary staff (nurse) is the one seeing the patient to carry out his orders from a previous encounter and he must be present in the office suite area while the patien tis being seen.


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## Stefanie (Sep 1, 2010)

Where are the rules for this?  I believe I just asked a similar question about ancillary services.  Let me just clear this up for my peace of mind...we do INRs for outside ordering physicians, but we are not a anticoagulation clinic, the nurse sees the patient, reviews and documents all appropriate information to qualify for a 99211.  Currently we are billing under a "Nurse Visit" which is assigned a specific "rendering doctor" who may or may not be on-site when the visit occurs.  That leads me to a few questions; We have to bill under a "rendering physician" who is on-site, correct? That includes all services done by a MA/RN/EMT/LPN, the "rendering physician" on the claim must be on-site when the services are performed?  Back to the 99211 and anticoagulation, the "rendering physician" on the claim, must also be the provider who signs off on the note, correct?  

If anyone has any suggestions, please, let me know.  I am struggling because I have only held the coding manager position in this company for less then 2 years and I am still trying to get them on the right track.  Sometimes it's harder then others and this situation is hard.  They have been doing what's easy for too long.  I need documentation to support my request for change regarding ancillary services.  Any help is much appreciated.

Thank you.


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## cheermom68 (Sep 1, 2010)

*99211*

See  MLN from Medicare for Incident to if billing for Medicare or any carrier that follows Medicare guidelines these must be followed to bill 99211.

https://www.cms.gov/MLNMattersArticles/downloads/SE0441.pdf

Take special notice of the FAQ's regarding anticoagulation.


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## Stefanie (Sep 1, 2010)

cheermom68, thank you so much for the link.  It is going to be the foundation of chaos in our office in the next couple of weeks.  

What's your knowledge on shots, EKGs, laboratory tests etc.  What if the "rendering provider" name on the claim was not on-site during the test?  Do you have any info on these?  We are going live with our laboratory in October, I don't know who they have "assigned" to those services, but I am sure that provider will NOT be in the office for each lab test. 

Thank you so much for your time!!!!


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## cheermom68 (Sep 1, 2010)

*incident to*

Labs are not considered incident to, however procedures such as EKGs, injections are and would have to follow the guidelines just like the 99211.

I just had a thought, you are not an outpatient department of a hospital are you??
That would change things somewhat.

LeeAnn


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## Stefanie (Sep 1, 2010)

We are not an outpatient department of a hospital.  We are a med. sized primary care clinic with 3 locations.

Can I email you privately.  I have several questions and I am pretty much the only CPC for 60 miles.  Do you mind?


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## mitchellde (Sep 1, 2010)

Stefanie said:


> Where are the rules for this?  I believe I just asked a similar question about ancillary services.  Let me just clear this up for my peace of mind...we do INRs for outside ordering physicians, but we are not a anticoagulation clinic, the nurse sees the patient, reviews and documents all appropriate information to qualify for a 99211.  Currently we are billing under a "Nurse Visit" which is assigned a specific "rendering doctor" who may or may not be on-site when the visit occurs.  That leads me to a few questions; We have to bill under a "rendering physician" who is on-site, correct? That includes all services done by a MA/RN/EMT/LPN, the "rendering physician" on the claim must be on-site when the services are performed?  Back to the 99211 and anticoagulation, the "rendering physician" on the claim, must also be the provider who signs off on the note, correct?
> 
> If anyone has any suggestions, please, let me know.  I am struggling because I have only held the coding manager position in this company for less then 2 years and I am still trying to get them on the right track.  Sometimes it's harder then others and this situation is hard.  They have been doing what's easy for too long.  I need documentation to support my request for change regarding ancillary services.  Any help is much appreciated.
> 
> Thank you.



The rendering physician is required to be onsite while the patient is being seen.  Also an RN or MA ma not be the initial provider the patient sees for a new problem, they must have been evaluated previously by the physician and that physician must have a plan of care documented in the chart that includes the probability of a followup encounter with ancillary staff.  Ancillary staff may not see a patient for a new problem then go back and present the issue to (or call) the physician to obtain orders on how to proceed and bill the encounter.  The rendering/supervising physician does not have to be the physician that originally saw the patient but must be in the same practice and same specialty as the initial physician.  Box 17 and 17b of the 1500 will have the name and NPI of the physician that saw the patient originally and box 24J will have the NPI of the physician that is on site, this must then match the signature on line 31.
I hope this helps.


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## cheermom68 (Sep 2, 2010)

*99211*

Sure just send me a private message through this forum.
LeeAnn


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## coder2533 (Sep 30, 2013)

Do you have a good resource that states that the rendering physician must be on site? We have nurses who give injections without the patient seeing the doctor and we are being told to use the patient's normal provider, even if they are not on site. I am struggling to find documentation to support my opposition to this.


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## mitchellde (Sep 30, 2013)

The claim form if nothing else..... the NPI used in field 24J must be the rendering or supervising provider.  If the provider whose NPI you're using is not on site then they can be neither rendering or supervising.  Also look under RN responsibilities in the internet.


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