Gastroenterology Coding Alert

Experts say that if you can report this code, you should Do you think you-re using 99211 appropriately? Find out by learning three criteria and then taking a three-scenario challenge.

Heads up: Although you probably refer to 99211 as the -nurse's code,- your gastroenterologist and other personnel should report it if an E/M visit doesn't meet the documentation requirements of the higher-level established patient E/M codes (99212-99215).

Our coding experts recommend that you report 99211 (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) if the service meets these three principles: 1. Staff Performs an Actual E/M Visit

To report 99211, a practitioner must perform an E/M service. In other words, don't use 99211 simply to get any simple service paid.

Example: A nurse speaks to a patient on the phone and agrees to obtain a prescription refill for her. The patient comes to the practice an hour later, and the nurse hands her the prescription through the reception window.

Solution: Because the nurse did not evaluate the patient and no medical necessity required that she meet with her, you should not report an office visit. If the nurse couldn't renew the patient's prescription without evaluating her, however, she should have documented the medical necessity to support billing 99211.
 
Anytime you report 99211, the nurse should document the reason for the visit, a brief history of the patient's illness, any exam processes such as weight or temperature, and a brief assessment.

What to look for: Check the documentation for notes such as -Wound has healed well,- -Blood pressure is serve as proof that the practitioner met with the patient
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-I look for the patient's vitals, where the practitioner made the injection, and the drug specifics,- says Cindy Foley, billing manager for Samuel S. Badalian, MD, PC and Nesim Contente, MD, PC in Syracuse, N.Y.

Also, make sure you have the date of service, the reason for the visit, proof that the nurse performed the service per the physician's order, and the nurse's signature, says Loretta Sacco, CPC, insurance/coding coordinator for IHA of Ann Arbor PC in Michigan.

Did you know? Any qualified personnel who are employees of the gastroenterologist can report 99211, including medical assistants, licensed practical nurses, technicians and other aides working under the physician's direct supervision. 2. The Service Is Medically Necessary If you think all nurse visits warrant using 99211, you could land in compliance hot water.

Example: A patient comes into the office for a blood pressure (BP) check because she recently had a high BP reading. Today's reading is normal. 

Solution: -If the patient [...]