Wiki PEDORTHIST

[LWATSON191]

Our pedorthist saw a patient to go over her footwear and feet to determine the proper Medical Grade Insert that would work with her foot type. Can he bill a 99211 for this?

 

[podcoder70]

99211 is defined as "evaluation and management of an established patient". The code levels are now based on "medical decision making" however, this low level code has no MDM assigned to it. As with all services billed to Medicare or a MAP, procedure code 99211 services must be reasonable and necessary for the diagnosis or treatment of an illness or injury. I found the following paragraph with NGS Medicare: "An evaluation and management (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." and "Instead, the medical record must include sufficient information to support the reason for the E/M service with relevant history, physical exam, and plan of care. The date of service and the identity and credentials of the person providing the care should be noted along with any interaction with the supervising physician."
Here is that link: https://www.ngsmedicare.com/pt/eval...e=97178&rgion=93623&selectedArticleId=3128150
With all of that said, if the visit is solely related to a non covered DME item or non covered service, then the visit would also not be covered.