Wiki Nurse visit and office procedure

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amanda19791

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My office is wondering why I do not bill the nurse visit(99211) with office procedure(granulation tissue removal). I explain that it is a NCCI edit. My office would like to have documentation stating why. I tried looking the NCCI website for further clarification. Do anyone know where I could find references for regarding E&M and procedures(office)?
 
CCI edits state that the 99211 is normally a component of the procedure (17250) but that a modifier is allowed to differentiate between the services provided. With that said, what type of limited services are being completed under the 99211 that would be significant and separate from the procedure?
 
Without reviewing the medical records it is difficult to answer whether or not the services rendered justify the billing of a 99211 and a procedure. However...from a general perspective since a 99211 is generally a minimal to limited service; if during the check of the tube the provider determines that a procedure is needed to address the tissue I would not normally assume that I would need to bill a 99211 and a procedure. In order to bill and get paid for both a modifier 25 would be needed to identify a significant and separate service. It would not be my first inclination that a modifier 25 would be warranted.

Again...it all comes down to the documentation.
 
Nurse visit

Open revision of gastrostomy Procedure 1/24

The patient was placed in the supine position. Adequate anesthesia was induced. The patient was sterilely prepped and draped in a standard fashion. An upper midline incision was created and dissection carried down until the abdominal cavity was entered without injury to the underlying structures. The prior G-tube was removed. The G-tube was visualized external to the stomach. The gastrotomy was identified. The prior pursestring suture was removed. The stomach was secured to the anterior abdominal wall in a Stamm fashion, and the new 14 French 1.0 cm Mickey button gastrostomy tube was placed through the abdominal wall defect and into the gastric lumen through the gastrotomy. A new PDS suture was placed prior to this maneuver, and after the G-tube placed into the gastric lumen, the PDS pursestring suture was tied into place. The remaining fixation of the stomach in a Stamm fashion was completed with Vicryl suture. Multiple checks of the balloon demonstrated that it was holding volume. The abdominal cavity was thoroughly irrigated. The fascia was closed with Vicryl suture in a running fashion. Monocryl suture was utilized in a subcuticular fashion to close the skin incision. Dermabond was applied externally. The procedure was well tolerated, and there were no complications.

Nurse visit 2/21

Granulation tissue, cauterization

Granulation treated with silver nitrate and dry dressing applied. Dr. in the office and available.
 
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