Pediatric Coding Alert

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.

A New Ritalin Refill Procedure

Also, Columbia Pediatrics Medical Group has devised a new Ritalin refill procedure, and 99211 is central to its success. Four times a year the patient comes in for a triplicate prescription. The nurse weighs the patient and checks his or her blood pressure. The pediatrician peeks in while were doing it, says Holford. If anything more than a peek takes place, 99212 is used. However, its usually 99211. Holford feels this is a good combination of monitoring and convenience for the parent; in addition, 99211 indicates that an office visit is occurring. Four times a year isnt onerous for the parents, whereas every month, says Holford, would be too much.