Otolaryngology Coding Alert

You can report a nurse-only visit with confidence as long as you apply the code when the nurse provides a service that payers deem medically necessary to an established patient.

Coding experts recommend that you 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. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services) if the service meets these three criteria:

1. Staff Perform an E/M

To report the lowest-level established patient office visit code, a nurse must perform an E/M service. Don't use 99211 simply to get a service paid, says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis.

Look for notes such as "Skin looks fine," "Blood pressure is normal," or "Condition controlled with medication." Documentation that includes a chief complaint or history also indicates that the nurse performed a service, says Jaime Darling, CPC, certified coder for Graybill Medical Group in Escondido, Calif.

2. The Service Is Medically Necessary

Performing a skin check alone doesn't warrant 99211 - the service must also be medically necessary.

If your allergist tells a 15-year-old female patient with acute eczema (692.9) to return to his office every six months for a check, this situation may call for 99211, coding experts say. The check is medically necessary to keep track of the patient's skin condition.

3. The Patient Is an Established Patient

You may report 99211 only for an established patient. Code 99211 is CPT's way of offering "incident-to," Buechner says. The code represents a relatively simple delegated service that staff perform under a physician's supervision.

Any qualified employee who performs the service may report 99211 incident-to your allergist. The physician must authorize, supervise (be present in the office suite) and sign off on the E/M service, Buechner adds.