Neurology & Pain Management Coding Alert

Question: Can we use 99211 on a new "unestablished patient" if they are seen to get their blood pressure checked or a prescription refilled prior to their first visit and establishing with the neurologist? Or would you not charge these so as not to utilize your first patient contact with a low level visit?

 

Ohio Subscriber

 

Answer: This depends on who is performing the service. If you plan to bill the 99211 for a nurse whose services are billed "incident to," you cannot bill for his or her services on a patient's first visit to the practice.  HCFA's incident to billing guidelines state that the physician must originally see the patient for his or her first visit to the office or clinic. Therefore, if the patient is coming for a blood pressure check with the nurse before the physician has examined her, the nurse cannot bill incident to for his or her services.

 

In addition, it's normally not recommended for physicians to refill prescriptions for patients who have not previously been seen by the practice, and refilling prescriptions will almost never meet the criteria for billing 99211, or any other E/M code.  

 

There is one scenario that may warrant billing incident to for the patient's first visit:  If the neurologist saw the patient for a consult requested by another physician, and your practice billed a consultation code (99241-99245) for that visit, then the neurologist has already performed a full exam of the patient. Therefore, if the patient's care was subsequently transferred to that neurologist and the patient simply needed to be seen for a blood pressure check before his or her first office visit, the practice could bill 99211 for that service. However, the visit would have to meet the documentation requirements of  99211, and a simple blood pressure check would probably not do so. Additional criteria would have to be met to warrant billing an E/M code.

 

Either way, if a new patient has a concern serious enough to require a blood pressure check or a new prescription, you should forget about billing 99211 and try to work them into the neurologist's exam schedule.