Primary Care Coding Alert

Question: A medical assistant (MA) gives a patient an allergy shot, checks his blood pressure and weighs him. May I report the service with 99212 instead of 99211?


North Carolina Subscriber

Answer: In the circumstances you describe, you should not use 99212 (Office or other outpatient visit for the evaluation and management of an established patient -) to report the services that you describe.

First, you should separately code the allergy injection using the appropriate allergen immunotherapy code, such as 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection).

After coding the injection, which includes related monitoring work, you have only the BP and recording of weight to capture. Code 99212 requires two of the following three things: a problem-focused history, a problem-focused exam, and straightforward medical decision-making. Because you describe only recording BP and weight, the encounter probably involves no history or medical decision-making. Therefore, 99212 would be inappropriate.

Even if the encounter involved other identifiable services that warranted reporting 99212, you would still be stuck with 99211 for the MA's work. MAs like nurses do not typically report higher-level E/M services as nurse practitioners may.

Best bet: Code the encounter with 99211 appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). If a patient requires a BP and weight check, the services are probably for a different problem than immunization administration-related services, which makes 99211-25 OK. Just make sure the chart contains documentation of the other problems.