Orthopedic Coding Alert

Question: A patient with a broken toe didn't think she was retaping the fracture properly after she showered each day, so our nurse spent 10 minutes showing her how to tape it. How do we get paid for the nurse's time?

Michigan Subscriber

Answer: You can collect reimbursement for the nurse's time by reporting a level-one office visit code (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).
 
CPT specifically designed 99211 for services that may not require the skill and expertise of a physician. And, Medicare incident-to rules allow auxiliary physician employees, such as technicians or aides, to bill 99211, according to section 2051.1 of the Medicare Carriers Manual. The assistant must be qualified to perform the service and be supervised by a physician who is present in the office.
 
Code 99211 differs from the other office visit codes in two ways. First, 99211 is included in the established patient office visit series (99211-99215) only. The new patient office visit codes (99201-99205) do not offer a similar nonphysician code. To report the nurse's time, the physician must have previously seen the patient.
 
Second, unlike the other office visit codes, which require history, examination and medical decision-making, a level-one office visit does not require these three elements. So, to prove medical necessity for the nurse visit, documentation should include the complaint, the advice that the nurse offers, and the diagnosis. In addition, the nurse must take an assessment, such as checking the vitals or weighing the patient.