Internal Medicine Coding Alert

Question: We often refill patients' prescriptions but don't know how to charge the insurance carriers for this service. Even though the physician never sees the patient to discuss the prescription, can we report 99211?


Wisconsin Subscriber


Answer: You shouldn't 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) simply for a prescription refill. When billing 99211, remember these tips:

Report the code only when the physician or a qualified staff member provides covered medical care to the patient in your office. The patient must present with a chief compliant (for example, stomach cramps, 789.0x, Abdominal pain). The care normally required for this level of visit would include services such as treating a reaction to current medications.

Don't report 99211 when the patient presents for a routine blood pressure check, an injection or a blood-sugar test if the physician or staff perform no other medically necessary services.
 
Your internist must provide "direct supervision" of the visit. This means the physician has to be on the premises during the service.