Primary Care Coding Alert

Find out what will turn a nonreportable service into a nurse visit

If you're unclear on how to use the lowest-level established patient E/M code, quiz yourself on which of the following five scenarios warrant 99211.

1. A patient drops off a urine specimen.

You shouldn't charge 99211 for a urine specimen drop-off. The nurse doesn't perform an E/M service, says Jaime Darling, CPC, certified coder for Graybill Medical Group (nine family physicians), in Escondido, Calif.
 
For the specimen handling and conveyance, you may report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

2. A patient presents for a blood draw.

If the patient comes in only to have blood drawn, you should charge 36415 (Collection of venous blood by venipuncture) instead of 99211.
 
But you may report 99211 if the registered nurse takes a history of the patient or documents a chief complaint, Darling says. Some carriers, however, may bundle the E/M service with the venipuncture code.

3. A patient picks up a prescription refill from the receptionist.

Don't bill 99211. No face-to-face contact or E/M service occurs.
 
But you may report 99211 when the patient presents with a problem that involves the nurse's services. Suppose when a patient comes in to pick up his Ritalin refill, he complains to the receptionist that he's still having difficulty concentrating. The nurse documents the problem and checks with the FP regarding changing the patient's dose. Because the service involves the nurse and a problem, you may bill 99211, says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis.

4. A nurse documents a blood pressure check for a patient in which the chief complaint is hyper-tension (401.1, Essential hypertension; benign).

Bill 99211. The nurse documents a chief complaint, Darling says.

5. A nurse administers a B12 shot.

Usually, the administration code (90782, Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) covers the nurse's work, so you shouldn't report a nurse visit, Darling says. But if the nurse documents the patient's current condition, such as "Patient is vitamin B12-deficient (266.2) and complains of fatigue (780.79)," you may use 99211, Darling says.
 
In fact, CPT Appendix C uses the above example as an accepted 99211 vignette, Buechner says. "This is a good list to use as a guide," he adds.
 
Be careful: Medicare will not pay for administration codes 90782 and 90788 (Intramuscular injection of antibiotic [specify]) with any E/M code, including 99211, Darling says.