Colliemom
Expert
If you read the code description for a 99211 it specifies that the established patient office visit may not require the presence of a physician. If you go to Appendix C in the CPT one of the examples of when to use the 99211 is: an office visit for an 82 year old established patient for a monthly B-12 injection.
So this suggests it is appropriate to bill an established patient office visit when a patient is only coming in for monthly injections. (honestly though, I do wonder if medical necessity is being met in this instance, why would you need to bill an office visit if the patient is just coming in for an injection? Would it be because the NPP wants to check the patient's current vitals and perform a constitutional exam to be certain the patient was not feeling ill before proceeding with an injection? I could then understand the need to perform a 99211 before the injection if this were the case.) My first question would be what kind of documentation would the NPP have to create to support a 99211? If the patient is only coming in for monthly injections, and the physician does not need to be present, then you would not have a complete SOAP note. What type of documentation would you need in order to bill this low level E/M visit? Also, if the NPP is performing the injections at the request of the supervising physician, then would it be appropriate to bill the 99211 as "incident to?" How about the actual injection, would you also bill that as "incident to," since the NPP is simply following the plan of care established by the supervising phyisican?
Now let's make it a little more complicated...suppose the established patient comes in to the office, is seen by our APRN for not only a Cimzia injection but to teach the patient how to perform the injections herself. In this instance the APRN spends 45 minutes with the patient, and 30 minutes of the visit is spent in counseling the patient on how to perform the injections. Would it be appropriate for us to bill an established patient visit, 99215 based on time, as "incident to" along with 96401 for the injection?
Sorry for asking so many questions, we are trying to get a handle on how we should be billing for our new APRN.
So this suggests it is appropriate to bill an established patient office visit when a patient is only coming in for monthly injections. (honestly though, I do wonder if medical necessity is being met in this instance, why would you need to bill an office visit if the patient is just coming in for an injection? Would it be because the NPP wants to check the patient's current vitals and perform a constitutional exam to be certain the patient was not feeling ill before proceeding with an injection? I could then understand the need to perform a 99211 before the injection if this were the case.) My first question would be what kind of documentation would the NPP have to create to support a 99211? If the patient is only coming in for monthly injections, and the physician does not need to be present, then you would not have a complete SOAP note. What type of documentation would you need in order to bill this low level E/M visit? Also, if the NPP is performing the injections at the request of the supervising physician, then would it be appropriate to bill the 99211 as "incident to?" How about the actual injection, would you also bill that as "incident to," since the NPP is simply following the plan of care established by the supervising phyisican?
Now let's make it a little more complicated...suppose the established patient comes in to the office, is seen by our APRN for not only a Cimzia injection but to teach the patient how to perform the injections herself. In this instance the APRN spends 45 minutes with the patient, and 30 minutes of the visit is spent in counseling the patient on how to perform the injections. Would it be appropriate for us to bill an established patient visit, 99215 based on time, as "incident to" along with 96401 for the injection?
Sorry for asking so many questions, we are trying to get a handle on how we should be billing for our new APRN.
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