Ophthalmology and Optometry Coding Alert

Question: An established patient visited our office to receive an injection. The nurse administered the injection and the patient left. The nurse wants to report 99211 along with the injection code, but the coding director says we cannot do that. Who is right?

Texas Subscriber

Answer: Based on the information you’ve provided, it sounds like the coding director is right. The main obstacle to correct coding for nurse-administered injections is knowing whether the nurse and the ophthalmologist met the parameters for reporting 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…).

A patient physically visiting the office and seeing your nurse does not always translate to a 99211 code on the bill. If the office visit is conducted solely for the purpose of injection administration, you can’t typically report 99211.

If the nurse is going to bill for the office visit, they have to monitor the patient before or after the injection. An example of “monitoring” would be checking the patient’s blood pressure, reviewing other vital signs, or observing the patient for any post-injection reactions.

When the nurse does nothing but administer an injection, the visit must be billed using the appropriate injection code, such as 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular).

You can’t report both: The National Correct Coding Initiative (NCCI) bars you from reporting 99211 and 96372 together, noting, “Code 99211 is a column 2 code for 96372. You may not override the edit.” Therefore, there are no circumstances when you can report both codes together, even if you append a modifier.