Gastroenterology Coding Alert

Question: How should we bill for Humira injections when we do not purchase the medication? The patient is purchasing it and then our registered nurse (RN) instructs him. She will perform the first injection, showing the patient how to do it, and provides some counseling. Then she'll observe the patient give himself the second injection, and then the patient starts injecting himself the rest of the time at home.

Texas Subscriber Answer: As long as the physician is present in the facility, you can 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. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) for the nursing visit where she provides instruction and counseling.

Keep in mind: You should never report a code simply to get paid. To report 99211, a practitioner must perform an E/M service. Make sure you have the date of service, reason for the visit, proof the nurse performed the service per the physician's order, and the nurse's signature. You may also want to look for documentation of the patient's vitals, where the nurse made the injection, and drug specifics.

Most practices won't bill for the second Humira injection because the patient self-administers the shot with the medicine pre-purchased.