Pediatric Coding Alert

Office Visit Without a Pediatrician:

Using 99211 to Your Best Advantage

Sometimes your patients come to your office but dont see a pediatrician. They see a nurse, perhaps for an injection, but that is all. There is a code for this: 99211. It is not for a new patient, only for an established patient. And while it may be used if a pediatrician sees the patient, it is one code which does not require the presence of the pediatrician. The presenting problem should be minimal, and only five minutes need be spent on the visit.

Examples of 99211 use given in CPT include a supervised drug screen of a 19-year-old, a check of a hematoma one day after venipuncture of a 12-year-old, and redressing an abrasion in a 14-year-old.

We use 99211 quite often, says Sometimes your patients come to your office but dont see a pediatrician. They see a nurse, perhaps for an injection, but that is all. There is a code for this: 99211. It is not for a new patient, only for an established patient. And while it may be used if a pediatrician sees the patient, it is one code which does not require the presence of the pediatrician. The presenting problem should be minimal, and only five minutes need be spent on the visit.

Examples of 99211 use given in CPT include a supervised drug screen of a 19-year-old, a check of a hematoma one day after venipuncture of a 12-year-old, and redressing an abrasion in a 14-year-old.

We use 99211 quite often, says Diane Harris, office manager for North Raleigh Pediatrics, a seven-pediatrician practice in Raleigh, NC. The pediatrician does not see the patient, she notes. In Harris office, 99211 is used most frequently for rapid strep tests, for one-week visits (when a one-week-old baby comes in for a weight check, an immunization, or both), and for 15-month immunizations. Managed care does reimburse them for 99211.

At the Pediatric Center, a five-pediatrician, one nurse-practitioner practice in Stamford, CT, 99211 is used only for immunizations. We use it in combination with the appropriate immunization code, says insurance coordinator Virginia Vaccaro. Not all companies will actually reimburse for 99211, she says. But we try.

And at Columbia Pediatrics Medical Group, a five-pediatrician practice in Long Beach, CA, 99211 has just been added to frequently used codes. Were just starting it out, says office manager Kim Holford. But the code isnt only being used for immunizations and weight checks. It is also used for patients on WIC for certain required checks, such as hemoglobin lead levels.

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