EM Coding Alert

Question: Can you report 99211 for new patients?

Illinois Subscriber

Answer: No, you cannot bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional ...) in this situation. "Use of 99211 is strictly for established patients - never a new patient since there must be a plan of care with the plan documenting a brief follow-up E/M encounter," says Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey. "This follow-up E/M can be performed incident-to, meaning not requiring a physician to perform the service."

"99211 is only for established patients because it is technically performed incident-to, meaning the ancillary staff nurse will be using the supervising provider's billing information to get the practice paid for the work," adds Shannon O. DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, partner at DoctorsManagement, and president of NAMAS in Melbourne, Florida. "In order to meet the guidelines associated with incident-to, the patient must have a plan of care that has already been created by a supervising provider. The nurse would be providing following services directly indicated and/or appropriate to the plan of care."