Neurology & Pain Management Coding Alert

If a visit warrants a low-level E/M, you can recoup an additional $20 or more

If you're treating 99211 as a "nurses-only" code, you're missing out: Neurologists and other personnel -- not just nurses -- should report 99211 only when the practitioner provides a medically necessary service to an established patient and the E/M visit doesn't meet the documentation requirements of the higher-level E/M codes (99212-99215).

Specifically, coding experts recommend that you 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. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) if the service meets three criteria:

To report 99211, a practitioner must perform an evaluation and management service. Don't use 99211 simply to get any simple service paid, says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis. For example, if the nurse provides a patient with instructions over the telephone on how to take medication, you cannot report an E/M service.

"I advise physicians that for nurse visits, the nurse should document the reason for the visit, a brief history of the patient's illness, any exam processes such as weight or temperature, and a brief assessment," says Jay Neal, an independent coding consultant in Atlanta. If the nurse does this, you can report 99211 and recoup an additional $20 or more for the visit.

Check documentation for evidence of an E/M service: Look for notes such as "Wound has healed well," "Blood pressure is normal," or "Condition controlled with medication" to serve as proof that the practitioner met with the patient,

Code 99211 is NOT just for nurses: Any qualified personnel who are employees of the physician can report 99211, including medical assistants, licensed practical nurses, technicians and other aides working under the physician's direct supervision.

Suppose the neurologist is treating a patient for low-level carpal tunnel symptoms. The neurologist shows the patient how to apply splints to her wrists and provides advice for use and maintenance of the splints. The following day, the patient has difficulty with the splints. She returns to the office, and the nurse reapplies the splints and provides additional instruction. The nurse should report 99211 for this service.

Not all nurse visits will warrant reporting 99211, however. Suppose the patient phones your office asking for another splint. She returns to your office, where the nurse simply hands her a new splint. Because the nurse did not provide an E/M service in this case, you should not report 99211.

The new patient E/M codes do not offer an equivalent to 99211. Registered nurses cannot report 99201, the lowest-level new patient office visit code.

Remember: A physician must see new patients, or established patients who have new problems, before you can report 99211. For example, an established patient with a previous diagnosis of migraines comes to the office with a complaint of numbness in his hands. Even if the complaint is minor, the neurologist must see the patient, because this is a new problem. On a subsequent follow-up visit for the same problem, however, the nurse could see the patient and report 99211.