Otolaryngology Coding Alert

Question: Should our otolaryngologist report 99211 when she reviews labs/x-rays, etc., and orders additional testing or medication changes for skilled nursing facility patients? She does not see the patient face-to-face.

Ohio Subscriber

Answer: No. Although 99211 (Office or other outpatient visit for the E/M 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) does not require a physician's presence, it does require medically necessary direct contact between your office's incident-to employee and the patient.

For instance, if a patient with a sinus infection came into your office for a prescription change due to nausea from the medication and the nurse took the patient's vitals, recorded his problems and discussed the reaction with the otolaryngologist, who wrote a new prescription, you could bill 99211 under the physician's national provider identifier (NPI). But if a nurse discussed the reaction over the phone with the patient, and the patient just came in to pick up the prescription from the front desk, you should not use 99211. No direct service occurred between the patient and the physician's staff.

Some options for non-face-to-face services include telephone calls (2008 codes: 99441-99443, Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment -). Medicare, however, will not cover services for which the patient is not present.

Good news: Your otolaryngologist may not be giving away her reviews/med changes for free. E/M services include some related post-work time, so reviewing lab results might be included in the related nursing facility visit (such as 99251-99255, Inpatient consultation for a new or established patient -) in which she ordered the tests.

Remember: When your physician personally reviews a film, you should give her additional credit (two points) for independent review of films or tracings under medical decision-making. If the otolaryngologist refers to that review at the patient's next visit, the review may increase the E/M service's level if medical necessity based on the presenting problem's nature exists.