General Surgery Coding Alert
99211 Isnt Just for Nurses
Question: We employ a physician assistant (PA) who performs all levels of E/M services. We recently noticed that if he sees a patient just for a blood pressure check, he bills 99212. We think hes upcoding because those visits only require 99211. He says 99211 is for nurses only. Who is correct? Georgia Subscriber Answer: Your PA is incorrect. Just because 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) is the only E/M code that registered nurses can bill does not mean that it is a "nurses-only" code. Correct coding dictates that you bill for what you perform. For instance, if a physician, physician assistant, nurse or any other licensed medical professional sees an established patient with hypertension for a follow-up blood pressure check after a medication change, he or she could report 99211 because the service performed and documented did not meet the requirements for 99212 (Office or other outpatient visit for the evaluation and management of an established patient ... usually the presenting problem[s] are self-limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family). Even though 99212 is a lower-level E/M visit, it still requires the provider to perform and document at least two of the following three components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making. Note: A PA or nurse practitioner can report 99212-99215, but not lower-level employees such as registered nurses, licensed practical nurses or medical assistants. If the PAs visit did not meet these requirements and the U.S. Health and Human Services Department Office of Inspector General (OIG) sees that your PA consistently bills standard blood pressure checks this way, you could face problems if the OIG audits your records. Remind PAs and other nonphysician practitioners that they should bill for the services they perform, no matter how much medical training they have.
General Surgery Coding Alert
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A 99211 Coding Checkup
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99211 Isnt Just for Nurses
Question: We employ a physician assistant (PA) who performs all levels of E/M services. We [...] - Reader Question:
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Bill Incident-To the Resident Doc
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