Podiatry Coding & Billing Alert

Question: There has been debate in the office about which healthcare professionals can appropriately report 99211. Can you please clear up this confusion for us?

Maine Subscriber

Answer: It is a common myth that only nurses can 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 or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services). However, although it’s sometimes referred to as the “nurse visit” code, 99221 isn’t just for nurses.

Any qualified auxiliary personnel the physician employs can report 99211 — including the physician. This includes medical assistants (MAs), licensed practical nurses (LPNs), technicians, and other aides who work directly under the physician’s supervision.

“It’s still appropriate for a physician or nurse practitioner to use the 99211 if that’s all that their documentation and medical necessity actually meets,” says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida, “So, [99211] is not just a nurse E/M service.”

Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico echoes Mac’s thoughts about who can report 99211.

“While we usually refer to 99211 as a ‘nurse only’ visit, there are times when a billing provider has only documented this level of service (rather than, say a 99212) if that provider did not perform an exam or take a history and only documented medical decision making (for example),” Witt says.