Wiki about using CPT code 99211 for nurse visit in pediatrics

[roy.malobica@gmail.com]

Hi ,

I work as a medical coder and biller in a pediatrics office.
I have a question please. Can we use CPT code 99211 for PPD read done by nurse (like considered as a nurse visit)
Normally for a PPD placement,
We usually use ICD Z11.1 (PPD screening test) for PPD placement and CPT as 86580 (PPD)
and when we see the same patient back again for PPD read within 72 hours,
we code ICD as Z11.1 and CPT as 99211 (office visit- established patient) .

I want to ask if 99211 is an active code or not ?? Can we still use it ? Can Nurse read the PPD and then can we bill 99211 ?

It will be really helpful if someone can get back to me on this.



Thanks and Regards
Malovika Roy Bhattacharyya
ID: 01762378

 

[thomas7331]

99211 is still active and can be used. Keep in mind that services billed with this code must meet the definition of an 'incident to' service (i.e. only for an established patient, part of a physician's plan of care, and ordered by and performed under the supervision of a physician).

Using this code for reading of a PPD has been controversial in the past, but I think most professional societies these days argue that it is appropriate to use it for this. Here's a citation from the American Academy of Pediatrics addressing this:

https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fpublications.aap.org%2FDocumentLibrary%2FSolutions%2FPCN%2Fpcco_99211PPDReading2012%2520(3).doc&wdOrigin=BROWSELINK

 

[roy.malobica@gmail.com]

Thank you for your reply. Does the nurse need to be only a registered nurse or any other nurse can also do PPD read ?

Thanks and regards
Malovika Roy

 

[thomas7331]

Thank you for your reply. Does the nurse need to be only a registered nurse or any other nurse can also do PPD read ?

Thanks and regards
Malovika Roy

It doesn’t have to be a registered nurse, as long as the employee is properly and licensed/certified to perform the service.