Primary Care Coding Alert

Question: A representative does a pacemaker check, and a nurse takes the patient's vitals. May I report a nurse visit with 99211? If so, do I need a modifier on 99211?

Ohio Subscriber

Answer: No. Because no medically necessary reason exists for a separate and unrelated E/M during the pacemaker check, you should not bill the nurse's service as an E/M service (99211, Office or other outpatient visit for the evaluation and management of an established patient ...). You should instead consider the vitals' measurements part of the pacemaker check reimbursement.
 
Think of it this way: You wouldn't bill 99211 when a nurse, medical assistant or licensed practical  nurse takes a patient's vitals during an E/M visit (such as 99212-99215).
 
Watch out: The family physician, not the representative, bills for the pacemaker check. If the representative is in the office doing an instructional session, there is no charge for the education that the representative provides.
 
FPs rarely perform true pacemaker checks based on Medicare data. But if the physician does perform the check, you would bill the service with 93640-93642 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator ...) or 93741-93744 (Electronic analysis of pacing cardioverter-defibrillator ...).
 
Include the vitals' measurements as part of the pacemaker checks. Remember, to use the pacemaker check codes (93640-93642, 93741-93744), the FP needs to be present in the exam room.