Wiki 99211

[Urgentcareard1]

Can someone give me clear definition of when to bill 99211?

 

[tadapoof]

I'm looking for the same information.

 

[TThivierge]

Hi Tada and Urgentcare,
The CPT 99211 can be used by a nurse,doctor, or QHP in most specialties .Nurse can do BP checks, help pt get meds discuss with doc, wound checks, and do vitals if in office. They must document dx and assessment of visit. Phone calls CPT 98966-98968 for phone calls by RN or QHP. QHP or RN document properly how caring for patient, permission and minutes discussed with patient. They should be referred by attending doc NP PA MD if getting injection or meds.. You cannot use CPT 99211 for patient just getting injection or vaccines by the nurse. For these visits list vaccines and injection that nurse document reason, area on body ,time and amount of infectible .Use J codes or admin CPT 96371 or 90471 list Z23 or definitive dx if necessary.
I hope this data helps you
Lady T

 

[csperoni]

In my opinion, the only answer to "When should I bill CPT123?" is "Whenever the documentation indicates those services were provided and medically necessary."
99211 is typically used for non-clinician services under direct supervision of a clinician. There are 100 different scenarios that could result in 99211 being the correct code.
Examples:
1) Patient sees physician 10/01/2023 and is started on a new blood pressure medication. Physician instructs patient to return to office in 2 weeks for a blood pressure check. Patient returns 10/15/2023. MA takes blood pressure and reports to physician it is 110/78. Physician tells MA to tell patient to continue meds and follow up in 3 months.
2) Patient (not in a global surgical period) has an open wound requiring dressing changes. Patient has previously been seen 3 days ago and returns to office today. Patient has no additional complaints or issues. RN performs a dressing change and patient will return in another 3 days.

99211 is NOT to be used if the staff is also performing another service being billed for (blood draw, vaccines, EKG, etc.) 99211 is NOT to be used if the patient is also receiving E&M services by the clinician that day.

Do not forget that if you are billing 99211 incident-to, the ancillary staff requires direct supervision by the clinician (who must be physically present in the office suite.)

If you have a particular scenario that you are trying to determine whether 99211 is appropriate, a more detailed question providing those details would be helpful.