padelson1
Contributor
When a new patient is seen for shot Only. For patient first office visit, can I submit new patient E&M code, since first time it was a shot only.
When a new patient is seen for shot Only. For patient first office visit, can I submit new patient E&M code, since first time it was a shot only.
99211 is for established patients so for a new patient that comes in for an injection and receives that injection, it would be coded with the injection admin code such as 96372 plus the J code for the drug
99211 is established patient only. it is not used for either. You cannot have an incident to encounter if the physician has never seen the patient before. So for a new patient injection only the provider would need to be there and would need to at least look at the patient and approve the injection. A nurse or MA may not be the initial person to see the patient and make a decision regarding a treatment and then administer that treatment without the provider being face to face with the patient first. If the provider does not see the new patient at all then there can be no bill sent. If the provider sees the patient but does not document enough for a 99201 then you can bill the injection only. If the physician is not on site even for an established patient you cannot bill the 99211 as the provider must be on site when ancillary personnel are treating patients per prior orders. That notation in the CPT book is there for outpatient facilities where there is many times not a physician in the clinic when an injection is given.
But again a 99211 is for established patient only and only for physician use or when a physician is on site supervising a patient he has previously treated.
you cannot cange from new pt to est just because you do not meet the requirements for new patient and you may not Bill for services when a provider is not in the office. The 99311 states physician nerd not be present and that means face to face but he must be within the office suite at tje time of service. If there is no provider in the office yjen what ate you using for the supervising/ rendering provider NPI? You cannot use tje number for a provider not there.We are reading a lot into the original question. The CPT book does not rule out the use of 99211 on a new patient, it is just generally used for established patients that "may not require the presence of a physician". It is the only E/M code that does not have specific levels of history, exam or medical decision-making. Did you know that if you have a new patient encounter that does not meet all the levels for a new patient visit, you can use an established E/M code to report the encounter?
We must also follow the other coding instructions when choosing codes. I assume the physician probably reviewed this patient's information and ordered the injection. This patient may have been referred from another physician or facility. The nurse followed the physician's instruction to administer the injection. The physician was not present, so we must follow the guidelines in the book as to how to code the encounter.
I beg to differ that the note regarding use of 96372 is for outpatient facilities only. When this code was established and the information regarding the use of it came out, it very specifically states "Physicians do not report 96372 for injections given without direct physician supervision. To report use 99211". It also states "Hospitals may report 96372 when the physician is not present". I have worked in small offices where the physicians may be at the hospital and not on site when a patient comes for a scheduled injection. In those cases we must use 99211 to report the service.
There may be differing opinions, I am just taking my information from what is instructed in the book for reporting this encounter.
you cannot cange from new pt to est just because you do not meet the requirements for new patient and you may not Bill for services when a provider is not in the office. The 99311 states physician nerd not be present and that means face to face but he must be within the office suite at tje time of service. If there is no provider in the office yjen what ate you using for the supervising/ rendering provider NPI? You cannot use tje number for a provider not there.
Dirty I disagree across the board
99211 is for established patients so for a new patient that comes in for an injection and receives that injection, it would be coded with the injection admin code such as 96372 plus the J code for the drug
Patient was only seen for shot by a nurse, so I only submitted Administration code for injection. However, what I am confuse about is , when the patient actually is seen by provider, on a different day. Is it appropriate to use New Patient code 99203-99205. Thank you
Patient was only seen for shot by a nurse, so I only submitted Administration code for injection. However, what I am confuse about is , when the patient actually is seen by provider, on a different day. Is it appropriate to use New Patient code 99203-99205. Thank you