Ob-Gyn Coding Alert

Question: I have a question regarding Registered Nurse (RN) visits. Can a nurse bill for a 99211 when the patient comes back for normal test results and abnormal test results?

My wild guess is if you have an abnormal test results the doctor needs to establish a plan of care. What about for PPD reading? I said yes, the nurse can bill a 99211 and immunizations. What about when the patient comes only for a flu shot or another vaccine that was planned but because the patient was in certain circumstances could not be given at the time of the visit? Do we only bill for administration of vaccine and vaccine, even if the nurse was the only one providing the visit?

Kentucky Subscriber

Answer: If the patient has an abnormal result, the provider who is giving her care should see the patient. You should not be bringing in patients to give them normal results, as there is no medical indication for doing so.

If an RN gives an injection, you should bill only the administration code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), not 99211(Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) — unless you have no billing provider in the office who is supervising, then you can only bill 99211. 

However, if this was a Medicare patient and the supervising MD was not present, you would not have a billable service at all. If it is a PPD reading, then yes, bill 99211 so long as the RN documents that an evaluation took place and does not simply state “PPD normal.” Remember that 99211, although not requiring the presence of an MD, is still and evaluation and management service and needs to be properly and accurately documented.