Pillow1
Guru
Can i bill for a 99211 + 36415 for A VENIPUNTURE OR JUST THE 36415 ?
THANKS FOR THE FEEDBACK/DENISE
THANKS FOR THE FEEDBACK/DENISE
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Wiki Can i bill 99211 with a 36415
- Thread starter Pillow1
- Start date
btadlock1
Guest
If all the patient came in for was to have blood drawn for labs (for example, the day after a doctor's appointment, so they could fast), it wouldn't be appropriate to bill an office visit (no E/M was really done at the time). But, if the nurse checked their BP, weight, temp, etc. and documented their status, then you can justify the 99211. It'll just depend on your notes. Hope that helps!
btadlock1
Guest
There's an article that explains it better than I did:
http://www.aafp.org/fpm/2004/0600/p32.html
"Basic guidelines
The following guidelines can help you decide whether a service qualifies for 99211:
•The patient must be established. According to CPT, an established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years. Code 99211 cannot be reported for services provided to patients who are new to the physician.
•The provider-patient encounter must be face-to-face. For this reason, telephone calls with patients do not meet the requirements for reporting 99211.
•An E/M service must be provided. Generally, this means that the patient's history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
Keep in mind that if another CPT code more accurately describes the service being provided, that code should be reported instead of 99211. For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not required."
http://www.aafp.org/fpm/2004/0600/p32.html
"Basic guidelines
The following guidelines can help you decide whether a service qualifies for 99211:
•The patient must be established. According to CPT, an established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years. Code 99211 cannot be reported for services provided to patients who are new to the physician.
•The provider-patient encounter must be face-to-face. For this reason, telephone calls with patients do not meet the requirements for reporting 99211.
•An E/M service must be provided. Generally, this means that the patient's history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
Keep in mind that if another CPT code more accurately describes the service being provided, that code should be reported instead of 99211. For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not required."
MnTwins29
True Blue
Another twist
I have read the materials referenced here, and I don't believe they really answer the question, as I have the same question about using 99211 and 36415 on the same encounter. In my case, the progress note from the MD does have a brief history, so that requirement is met, the pt is established, and it is part of an ongoing treatment plan. So, this does meet 99211, but since there was blood drawn, is it appropriate to ADD 36415? I am not finding any reference that states this can or can't be done.
TY.
I have read the materials referenced here, and I don't believe they really answer the question, as I have the same question about using 99211 and 36415 on the same encounter. In my case, the progress note from the MD does have a brief history, so that requirement is met, the pt is established, and it is part of an ongoing treatment plan. So, this does meet 99211, but since there was blood drawn, is it appropriate to ADD 36415? I am not finding any reference that states this can or can't be done.
TY.
btadlock1
Guest
Brief Hx and some MDM for an established patient, and you don't have enough for 99212? Just curious, there....
I don't see any problem billing both, as long as they're distinct services, and the provider did more than simply draw blood - you don't want to double dip. If BP/vitals were taken, and/or some sort of management was documented, you should be fine - the codes don't bundle. You can't bill a 96372 w/a 99211, but there's no restrictions on 36415, as far as I know.
MnTwins29
True Blue
Thanks!
Thanks for answering the 99211/36415 question. As for the chance to use 99212, only mention of previous treatment plan was the labs were needed "as per treatment plan from previous visits." Not comfortable using that for an MDM level, so we were going with 99211. MD coded own note and used 99211, I concurred and we had the same uncertainty about using prior tx plan as MDM.
Thanks for answering the 99211/36415 question. As for the chance to use 99212, only mention of previous treatment plan was the labs were needed "as per treatment plan from previous visits." Not comfortable using that for an MDM level, so we were going with 99211. MD coded own note and used 99211, I concurred and we had the same uncertainty about using prior tx plan as MDM.
muschy
New
Hi, I also have a question; if the the pt is new 99204 and a veniputure was performed 36415 on the same day, can we bill these two codes on the first visit?.
Teresa Collins
Guru
Yes, you can as long as the documentation supports both services.
I hope this helps.
I hope this helps.
eperri
New
Hi, i noticed lately that
There's an article that explains it better than I did:
http://www.aafp.org/fpm/2004/0600/p32.html
"Basic guidelines
The following guidelines can help you decide whether a service qualifies for 99211:
•The patient must be established. According to CPT, an established patient is one who has received professional services from the physician or another physician of the same specialty in the same group practice within the past three years. Code 99211 cannot be reported for services provided to patients who are new to the physician.
•The provider-patient encounter must be face-to-face. For this reason, telephone calls with patients do not meet the requirements for reporting 99211.
•An E/M service must be provided. Generally, this means that the patient's history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
Keep in mind that if another CPT code more accurately describes the service being provided, that code should be reported instead of 99211. For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not required."
Hi - i noticed lately that most MCOs payers are not anymore paying for the 99211 when billed together with 36415. What should be the next best alternative? TIA
Most likely the insurances decided that 99211 & 36415 were being inappropriately billed & 99211 was not justified when pt presented for blood draw. IF you are using it appropriately and the patient is receiving additional services, I would appeal those claims. You could also contact the carriers to find out if they have a new policy.
To me, the best alternative is always to bill appropriately. That way if your claim is denied, you have justification for an appeal.
I hope that helps.
To me, the best alternative is always to bill appropriately. That way if your claim is denied, you have justification for an appeal.
I hope that helps.
Remember: Code 99211 is a column 2 code for 36415, so you have to append 25 modifier to 99211.
Prada
Contributor
Thank you, I was looking for this information. Mod 25 use with office visit codes and 36415. I think it should be highlighted in all the mod 25 tipsheets / fact sheets but never seen this scenario being mentioned.