I would like to here some opinions and advice. How do I know if I should code an office visit in these various scenarios? We work with a lot of diabetic patients who come in regularly to get nails trimmed and calluses shaved. Sometimes the provider will bill just an office visit, sometimes just the nails and calluses and sometime both procedure and office visit. The reason for the visits are either "qualified foot care" or "nail care". There doesn't seem to be any consistency.
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Wiki Do I need an E/M?
- Thread starter Lunap99
- Start date
nrood
Networker
This is my opinion....
If the patient comes in and it is known that they need nails trimmed and calluses shaved, I would say NO to the office visit.
If the patient comes in and provider sees the patient and asses that nails need to be trimmed and calluses shaved and then proceeds to do those things, I would say ok.
If the visit reason is vague, I usually look to see what the MA or Dr. inputs as why they are there. If note were to say: patient here today for nail trim. I would lean toward not billing the visit. On the other hand, if they were to say: Patient here for foot problems. I think I would just see how the note reads. Do they make the decision to fix the nail issue and calluses at that time or does it seem to lean toward they already knew the patient needed specific services before they walked through the door?
That is usually my thought process when billing for things like cerumen removal, Nexplanon insertions, etc. with an office visit.
If the patient comes in and it is known that they need nails trimmed and calluses shaved, I would say NO to the office visit.
If the patient comes in and provider sees the patient and asses that nails need to be trimmed and calluses shaved and then proceeds to do those things, I would say ok.
If the visit reason is vague, I usually look to see what the MA or Dr. inputs as why they are there. If note were to say: patient here today for nail trim. I would lean toward not billing the visit. On the other hand, if they were to say: Patient here for foot problems. I think I would just see how the note reads. Do they make the decision to fix the nail issue and calluses at that time or does it seem to lean toward they already knew the patient needed specific services before they walked through the door?
That is usually my thought process when billing for things like cerumen removal, Nexplanon insertions, etc. with an office visit.That makes a lot of sense, thanks, much.
We have a lot of older patients that come in on a regular schedule for nail trims. They sometimes schedule ahead and the appointment is called "nail trim" I feel like they shouldn't bill an office visit as well so I'm glad someone agrees.
Is there any documentation to support this so that I can educate my providers?
We have a lot of older patients that come in on a regular schedule for nail trims. They sometimes schedule ahead and the appointment is called "nail trim" I feel like they shouldn't bill an office visit as well so I'm glad someone agrees.
Is there any documentation to support this so that I can educate my providers?
kiralee2010
New
I work in pediatrics and we use a special code for nurse visits because there are times that children need to be updated on their shots but don't see a provider. Its usually 999NV just so we can run a report and see how many we are doing in a certain amount of time. This is normally used for MCD or MMC. For commercial we use 99211. https://www.aapc.com/blog/69067-99211-in-2021/
"Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as nursing staff, medical assistants, or technicians, who must document the visit just as a provider would. Common examples include hypertension or wound checks by a nurse or medical assistant. The new AMA definition of a “minimal” problem is a problem that may not require the presence of the provider, but the service is provided under their supervision. "
"Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as nursing staff, medical assistants, or technicians, who must document the visit just as a provider would. Common examples include hypertension or wound checks by a nurse or medical assistant. The new AMA definition of a “minimal” problem is a problem that may not require the presence of the provider, but the service is provided under their supervision. "
OpenClaims
Guest
If the procedure was planned prior to this date and the patient is solely coming in for the procedure, then you only code the procedure. If there are other concerns or conditions addressed at the visit that are included in the HPI, Exam, and A/P, then you can review that and see if it would warrant an E/M in addition to the procedure.