Wiki 99211 for allergy shots

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twinpw

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When a patient comes in for allergy shots and the nurse checks the pt's temp, BP, pulse and does a quick overview to see if any changes before adminstering the allergy shot, should the visit have a 99211 coded with the allergy shot? There is some confusion about this and I have been asked to provide documentation (ASAP) to support if the nurse visit with vitals constitutes a 99211 when the pt comes in for the allergy shot on a monthly bases, or documentation stating Vitals are included with the allegy shots. All info would be appreciated. Thank you in advance.
 
it is never appropriate to code a 99211 for a planned procedure. Every CPT code has built into it the necessary assessment to provide that service. You must take vitals before administering an injection, it is part of the procedure.
 
Thanks Debra. Where is the guidelines is it documented? I am asked to show the guidelines supporting that taking the vitals are part of the allergy injection codes and do not support 99211. Some of the staff feel that if there is the 5 minutes for taking vitals and if there was a questionable reading, the physician would be consulted, therefore a 99211 is used in addition to the allergy code. My thinking is that vitals are part of the injection code. Otheres disagree. I am requested to show supporting documentation. Thanks, Pam
 
you need to look in the internet under 99211 billing with an injection. There are numerous writings on this. Also there is a transmittal on the CMS website from several years ago. Or you can use the same logic as when a patient presents for a scheduled procedure with the physician, he cannot charge an ov and the procedure for the same date of service. This patient has already be assessed for the necessity of allergy injections. The MA or nurse cannot administer these with a blindfold on. You cannot give the injection if the BP is elevated or the patient has a temp. therefore the taking of vitals is inherent to the performance of the procedure. If the vitals are abnormal and the provider is consulted, the provider must see the patient face to face and document the encounter to bill a visit, you cannot use a 99211 if the MA consults verbally with the provider, lok at your incident -to rules for this.
 
this is from MCM chapter 12 section 30.5:
F. Chemotherapy Administration (or Nonchemotherapy Injection and Infusion) and Evaluation and Management Services Furnished on the Same Day
For services furnished on or after January 1, 2004, do not allow payment for CPT code 99211, with or without modifier 25, if it is billed with a nonchemotherapy drug infusion code or a chemotherapy administration code. Apply this policy to code 99211 when it is billed with a diagnostic or therapeutic injection code on or after January 1, 2005.
 
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