Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: Our registered nurse spent 45 minutes instructing a patient on how to inject himself with interferon. I know we can use code 99211 for this, but the CPT guidelines state that those visits should take only about 10 minutes. Because this took 45 minutes, can we use the preventive medicine, individual counseling codes (99401-99404)?

Janel Flachsbart
Consultants in Gastroenterology, Lincoln, NE


Answer: With hepatitis C striking an estimated 30,000 Americans each year, more gastroenterologists are looking for an economical way to teach their patients how to inject themselves with interferon, often the treatment of choice for the disease. The gastroenterologist also is responsible for educating the patient about the possible side effects to the drug and the follow up lab tests that need to be done.

One solution that many practices have hit upon is to have a nurse provide the patient education and use code 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) to report the evaluation and management (E/M) service. CPT states that 99211 may not require the presence of a physician, which means it can be used to report services provided by a nurse. The description goes on to say that typically, 5 minutes are spent performing or supervising these services.

Unfortunately, 99211 is the only code that can be used to report the administration of these services by a registered nurseregardless of the amount of time actually spent with the patient. Codes 99401-99404 (preventive medicine, individual counseling) cannot be used to report services performed by a registered nurse, and the counseling provided with these codes must be preventive in nature, not related to a diagnosed condition.