Reader Question: Established Patient

Question: My hospital has an outpatient infusion clinic where patients come for blood transfusions, chemotherapy, IV antibiotics and a few procedures. A physician does not see the patients for most of the encounters. The clinic has asked for my assistance in setting up a classification system. They want to use 99211 for all patients with three different levels of charges no charge, minor charge and higher charge all associated with the same CPT code. Can I do this?

Illinois Subscriber

Answer: Each hospital can set up its own fee system and charge master, but must adhere to it. Code 99211 is for an office or outpatient visit for established patients that might not require the presence of a physician. Your facility will have to decide about the appropriate charge for 99211 and use it consistently. Because each level of established patient encounters is defined by resource-based criteria, your facility should also identify its resources with different CPT codes and charges.

- Published on 2001-05-01