Wiki The use of 99211- your thoughts please

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brownie

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what staff are coidng for 99211?-
if a staff member sees a patient does a SOAP documented before the INR is taken- do you generally code 99211. We have a discussion going on this - what actually constitutes a documented 99211 and who can code for it and then bill under physician name...

there is no level of documentation given as requirements for 99211 (HX, ROS, EXAM , MDM, etc) - so this has come up many times with providers I have worked with in past- and just need some feed back form experienced coders how they address this to their providers when you feel it is being over-used
 
If the reason for the encounter is to draw blood for a PT/INR then that is all you can bill for. You cannot charge a visit level for the scheduled blood collection, you can bill only the blood collection code, the vital signs are a part of the blood collection code.
 
Our office bills a 99211 with PT/INRs because the MA has to visit with the patient and document the current dosage. After doing some research on the proper billing and speaking with protime clinic staff, it was concluded that it is proper for the 99211 to be bill. If a patient were going to a Coumidan clinic, they would be billed a 99211 besides the draw and test. I have not seen any denials from medicare or private payers.
Our patients are not scheduled, they come in at their leisure and the lab in our office (physician owned)
 
This is a hotly debated topic and has been for years. I have seen CMS describe what kinds of services would be appropriate to bill when an INR/PT are performed and managed on the same day. Here is the link from Novitas that has the identical information from CMS with a bit of elaboration on the information. So it would be useful no matter what MAC you were under.

Here is a short excerpt:
The interpretation of frequently recurring laboratory tests such as PT or INR and the communication of normal test results to a patient or patient's care giver is not by itself sufficient for the 99211 code. Factors which may support the 99211 code could include the need to adjust medication dose based on the test result or patient's clinical status."[/I]
https://www.novitas-solutions.com/bulletins/parta/archive/mpr03145.html
 
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