17 hours ago Code 99211 cannot be reported for services provided to patients who are new to the physician. The provider-patient encounter must be face-to-face. >> Go To The Portal
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.
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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.
CPT® 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.
The visit no longer meets incident-to requirements because there was a change in medication. You may not bill 99211; you may bill only the PT/INR. To bill for the evaluation and management (E/M), the provider must have seen the patient.
A patient presents for a prothrombin time and international normalized ratio (PT/INR). A nurse performs the test, gives the results to the provider, and relays a medication change to the patient. The visit no longer meets incident-to requirements because there was a change in medication. You may not bill 99211; you may bill only the PT/INR.
Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as a nurse or other staff member. Unlike other office visit E/M codes, a 99211 office visit does not have any specific key-component documentation requirements.
Unlike other E/M codes, CPT 99211 does not have any documentation requirements for the history, physical exam or complexity of medical decision making, however, supporting documentation in the patient record is required.
CPT code 99211 (established patient, level 1) will remain as a reportable service.
Even though non-face-to-face work can be counted toward office visits billed based on time, there has to be an encounter between the patient and the practitioner.
CPT 99211 Description: An outpatient visit or office visit of an established patient. A qualified healthcare professional (physician or other) may not be required. CPT 99212 Description: An outpatient visit or office visit of an established patient. The visit involves management and evaluation.
Code 99211 cannot be reported for services provided to patients who are new to the physician. The provider-patient encounter must be face-to-face. For this reason, telephone calls with patients do not meet the requirements for reporting 99211.
For existing patients, the time element was removed from CPT code 99211. For CPT code 99212, time for the encounter will be 10–19 minutes. Tenminute increments are used for codes 99213 and 99214. CPT code 99215 has a 15-minute time frame and is utilized for exams 40–54 minutes in duration.
Previously, the code descriptor stated, “Typically, 5 minutes are spent performing or supervising these services.” For dates of service on or after Jan. 1, 2021, you cannot bill 99211 based on time alone, as you can for the rest of the office visit codes.
To be clear, you shouldn't bill a meet and greet visit to a patient's insurer. Insurers, including government payors such as Medicare and Medicaid, reimburse only those services or procedures that they deem to be medically necessary—and a meet and greet doesn't meet the definition.
The physician's responsibilities include diagnosing and treating injuries, illnesses, and disorders, prescribing medications, making recommendations on lifestyle changes, and answering patients' questions.
The following codes may be used by physicians or other qualified health professionals who may report E/M services: 99441: telephone E/M service; 5-10 minutes of medical discussion. 99442: telephone E/M service; 11-20 minutes of medical discussion. 99443: telephone E/M service, 21-30 minutes of medical discussion.
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.
OFFICE VISITS FOR IMMUNIZATION Can code 99211, “Office or other outpatient visit for the evaluation and management (E/M) of an established patient that may not require the presence of a physician,” be reported when a patient presents for a flu shot? Code 99211 is not typically paid in the situation you describe.
By Karla M. Hurraw, CPC, CCS-P#N#CPT® 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem (s) are minimal. Typically, 5 minutes are spent performing or supervising these services is sometimes referred to as a “nurse visit,” probably because the code description specifies that the service, “may not require the presence of a physician or other qualified health care professional.” Offices often use this code for any service that a nurse provides, but this is not always appropriate.#N#Consider Credentialing Clinical Staff#N#If your nurse is credentialed and is billing using his or her own National Provider Identifier (NPI), he or she may report 99211. If your nurse is not credentialed, however, and bills under the provider’s NPI, the service must meet incident-to requirements. The nurse must follow an established, written care plan for that particular patient, to which there may not be any changes.#N#Note: Every payer I contacted when writing this article confirmed that a service provided solely by clinical staff must meet incident-to requirements to be billed under the provider. Payers differ, however, so it’s best to check with your individual payers to confirm their policies.#N#Examples:
You cannot report 99211; you may only charge for the UA. Tip: The best solution to avoid such cases is to credential your nurses (if the payer allows it). Don’t forget the role of medical necessity when reporting 99211. For example, a patient has an established diagnosis of hypertension.
The nurse must follow an established, written care plan for that particular patient, to which there may not be any changes. Note: Every payer I contacted when writing this article confirmed that a service provided solely by clinical staff must meet incident-to requirements to be billed under the provider.