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Wiki 99211 Help Needed!!
- Thread starter abeckett
- Start date
Leenahz
Guru
When I was working in primary care we would utilize 99211 with PT/INR checks. Also, if a patient came in to discuss HBP or diabetes and wanted to go over their readings and meds, etc. we would then use 99211 as well. Supporting documentation was entered in the HR and a doctor would review and sign as needed.
Hope this helps!
Lena
Hope this helps!
Lena
mitchellde
True Blue
To bill a 99211 for the provider to not be face to face with the patient, the physician must have examined the patient previously for the same diagnosis or issue and there must be a plan of care in the medical record for the patient to return for this reason. Also you cannot use the 99211 in lieu of an established CPT code for the same purpose. So for a PT/INR for the nurse to draw the blood is not a 99211, it is a blood collection encounter which has CPT codes for that purpose. If the patient has an order for regular or PRN BP checks then those are coded with a 99211. The provider must be in the office suite while the patient is there for these 99211 visits to be chargeable encounters.
careymvigor
Guest
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incident to billing
CMS changes the rules daily be careful In the olden days the doc did not have to see the patient now they do The extender must have their own Medicare PIN regardless and be able to bill independently of the doc As a rule of thumb if you meet the Medicare rules for 99211 and the incident to rules and the doc has seen the patient and documents the visit it should be ok but if the doc is only in the suite has not seen the patient then the doc signing the note may not be enough and could get the doc in trouble
CMS changes the rules daily be careful In the olden days the doc did not have to see the patient now they do The extender must have their own Medicare PIN regardless and be able to bill independently of the doc As a rule of thumb if you meet the Medicare rules for 99211 and the incident to rules and the doc has seen the patient and documents the visit it should be ok but if the doc is only in the suite has not seen the patient then the doc signing the note may not be enough and could get the doc in trouble
mitchellde
True Blue
However the provider does not need to see the patient face to face on the day the nurse sees the patient to perform a follow up,function. Only that the physician has examined the patient in a previous encounter for the same reason the nurse the seeing the patient and has a plan of care in the chart note for the patient to return for follow up care. As long as there are no new problems or change in the treatment the nurse can be the only one to physically visit with the patient as long as the provider is in the office suite.
pclaybaugh
Networker
I thought that this article explains it nicely and the information is current.
http://compliance.med.ufl.edu/compliance-tips/clarification-for-use-of-99211-code/
http://compliance.med.ufl.edu/compliance-tips/clarification-for-use-of-99211-code/
Leenahz
Guru
Debra, I understand your point, but perhaps I wasn't specific enough in my original post. When we utilized 99211 it was for the nurse visit, not the collection of blood. I understand the collection of blood is 36416 or 36415 and that is reported separately. The nurse would go over current meds and concerns with the patient, draw the blood, document the reading, consult with the provider for any needed adjustment to med(s), and relay the information to the patient.
Lena
Lena
mitchellde
True Blue
If there needs to be adjustment to the meds or any new issues then the provider must see the payient face to face for this to be a visit level. Incident to billing which is what you are doing means the one providing the service is adhering to a plan of care already established in the medical record. Any adjustments to the plan of care, which includes medication adjustment or new issues, takes this out of an incident to realm and the provider must see the patient face to face.
The 99211 is not a nursing level and that is where the misunderstanding comes in. It is a physician level that the physician may charge when a qualified staff person is following the orders or plan from a previous encounter while the provider is on site.
The 99211 is not a nursing level and that is where the misunderstanding comes in. It is a physician level that the physician may charge when a qualified staff person is following the orders or plan from a previous encounter while the provider is on site.
Leenahz
Guru
I understand the technicality you're addressing, but the nurse IS following orders set forth by an ordering physician for PT/INR regulation. Our office had a big to-do at the time of what could and couldn't be billed for and after many discussions and requests I was able to have our regional Medicare provider rep put in writing (CYA, right?) that we were within guidelines to bill and be reimbursed for the 99211.