Pediatric Coding Alert

Question: After calling for a refill, the parent of a 6-year-old with attention deficit disorder (ADD) comes to pick up the Ritalin prescription. The nurse verifies the patient's identity and gives the prescription you previously wrote. How should you treat this service?

Ohio Subscriber

Answer: You should consider this service part of the office overhead. The nurse did not perform the minimal face-to-face patient E/M components that a nurse visit requires. So you should not bill 99211 for the encounter.
 
But if the nurse performed and documented additional services, you could 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). 
 
Suppose when the parent in the above scenario comes to pick up the prescription, the nurse measures and reviews the child's height and weight. She then talks face-to-face with the mother, covering progress, improvement in target symptoms, and adverse reactions. The nurse offers suggestions about managing anorexia.
 
The nurse documents the above items in the patient's medical record. She also gives the mother a prescription for Ritalin and has the parent schedule a follow-up appointment in one month.
 
In this case, the nurse's services and documentation would support billing 99211. The visit involves face-to-face E/M.