Advantages for Coding Nurse-only Visits 99211
Published on Thu Jun 01, 2000
Evaluations between nurses and patients for routine follow-up visits or other minor services are common in neurology practices, but many subscribers have expressed concern about billing for a visit when the neurologist doesnt see the patient. Normally, the most accurate way to bill for a short nurse-only evaluation and management (E/M) visit is to use 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician).
The Typical Five-minute Nurses E/M
Typically, for a nurse-only visit, the presenting problems are minimal, and the normal visit time is five minutes, says Mary Mulholland, BSN, RN, CPC, reimbursement analyst in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. The time spent with the patient may vary with the needs of the patient. The nurse might render any range of services, including, but not limited to, vital sign checks, injection management, or review of self-medication administration, including a discussion of possible medication side effects.
Melody Mulaik, MSHS, CPC, president and co-founder of Coding Strategies Inc., a Dallas, Ga.-based consulting firm that supports more than 500 physicians nationwide, says, In a neurology practice, where patients with conditions such as seizure disorder (780.39) will come in for a Dilantin check to see if their medications need to be adjusted, the nurse will go over the results of the blood test with the patient. The nurse also would check vital signs and ask the patient if the seizures are under control.
Mulaik also says that nurse-only visits typically involve medication management and patient education. Injection management often is taught to patients with chronic migraines or multiple sclerosis who self-administer medication for their conditions. Many times, the nurses assist patients who have decreased mental status with medication management to ensure the appropriate doses are taken at the correct frequency.
When the Nurse Notices a Change in Condition
Mulholland says that the 99211 shouldnt extend too far beyond the suggested five minutes. There are no prolonged service codes or modifiers for extra time for the 99211 because anything that takes much longer than the normal five minutes is more complex than a registered nurse should be performing.
If, for example, a migraine headache (346.90) patient meets with the nurse to discuss how she is handling a new pain medication, but during the course of the visit, the nurse discovers that the patients blood pressure has risen dramatically, the nurse should bring in the neurologist. When the nurse, in the course of evaluating the patient, discovers an abnormality, a new problem or an exacerbation of an existing problem, he or she must notify the supervising neurologist, says Mulholland. Its [...]
