Anesthesia Coding Alert

Watch out:  Use this code as a catch-all and prepare to see your reimbursement-and compliance-plummet

The long E/M descriptors in CPT should clear up any confusion about how to use these codes. Unfortunately, this is hardly the case when claims that may or may not require 99211 come across coders' desks.
 
When tackling proper 99211 use, you must dissect the major components of the CPT descriptor: 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. Establish the Patient Status Component 1: Established patient status. As you can see in the above descriptor, the patient must be "established."

According to CPT, "established" means that your physician (or another physician of the same specialty in a large group) has treated the patient within the past 3 years. "My understanding of 'established' patient does not depend on the place of service," says Pam Marshall, IS and contract specialist with Northern Colorado Professional Services in Ft. Collins. "Even if your doctor [the patient] in another practice group and didn't bill an initial visit, that patient is still established." Double-Check for an E/M Service Component 2: Someone - but not necessarily the physician - has provided an E/M service for the patient. "This clinical service is in addition to any injection or other service performed the same day," explains Cindy Parman, CPC, CPC-H, RCC, president of the AAPC National Advisory Board and principal of the consulting firm Coding Strategies in Dallas, Ga.

Example: A chronic pain patient is starting on a medication that requires blood level monitoring. She comes to the office and receives face-to-face counseling (such as interpretation of the test, discussion of dietary concerns and interactions with other medications) from qualified office staff. The staff also evaluates the patient and modifies the patient's treatment regimen. This visit could qualify for 99211. Beat the Physician-Present Blues Component 3: The physician is not always required to be present in the office and immediately available at the time the service is furnished. Your physician doesn't have to provide the actual service, but that doesn't mean services provided in his stead automatically merit 99211. Instead, be sure the case fits the criteria outlined here before submitting 99211 - and be familiar with the individual carrier's guidelines.

CPT interpretation: Although physicians can report 99211, CPT's intent with the code is to provide a way for you to report services performed by others in the practice (such as a nurse or other clinical staff member). According to CPT, the staff member may communicate with the physician about the patient, but direct intervention [...]