Ophthalmology and Optometry Coding Alert

Question: What are the rules regarding exactly when I can bill 99211 for a nurse visit?

Codify Subscriber

Answer: You may 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 or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) when the nurse provides an E/M service that exceeds a simple task.

Example: A patient picks up a medication refill and tells the receptionist that the medication causes some unpleasant side effects. The nurse documents the problem and checks with the physician who is in the office during the patient encounter regarding changing the patient’s dose. Because the service involves the nurse and a problem, you can most likely report 99211.

Don’t forget to meet the documentation requirements for an E/M service, which include:

1. Reason for the visit: Documentation for code 99211 (or any other E/M code in this circumstance) must demonstrate a need for clinical evaluation and management (for instance, patient’s report of symptoms or signs that are significant enough to necessitate evaluation)
2. Indication of doctor’s evaluation of the clinical information obtained and her management recommendation
3. Identity and credentials of provider(s) listed.

Keep in mind, however, that if the patient just picks up the medication and leaves, that does not meet the medical necessity required for 99211.