this is an issue that has come up regarding whether or not the vitals are "required" for a 99211. this is a coumadin visit where the pt sees only the nurse and the dr reviews the results and signs off on the note (he is on site). the nurse does a finger stick to get the level and in most cases a 99211 is used....there are exceptions, of course, she then makes the determination for coumadin changes. the pt is advised of the change and any further instructions and these are all given by the nurse. we've looked in several different places for a specific answer, but they all seem a bit vague. can you help or give us a direction we can go in. we believe they should be done, but the manager is wanting something that is basically black and white. thanks in advance for your help.