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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.
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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 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.
All 99211 services must meet these three requirements of incident-to: The services are rendered under the direct supervision of the physician or nonphysician practitioner (NPP) (i.e., nurse practitioner (NP), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or in the case of a physician-directed clinic, the physician assistant (PA)). ...
CPT® code 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 confused many of us even before the new 2021 guidelines. Providers were trying to use it for quick visits with patients, which isn’t necessarily wrong … it was just potentially shortchanging them since 99212 is for straightforward medical decision making and should be the lowest level used by a provider in the office. Even with the new guidelines, that has not changed.
The term “scope of practice” refers to the regulations, which vary by state, specifying which services each staff can perform. Be aware of your state’s definition of scope of practice for each credentialed NPP to be sure they are qualified to perform the services described by 99211.
When billing incident to the physician, the physician must initiate treatment and see the patient at a frequency that reflects their active involvement in the patient’s case. This includes both new patients and established patients being seen for new problems.
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. A nurse can document the amount of time ...
If the patient sees a nurse for a dressing change as per the physician’s orders and the patient brings up another condition, the service no longer qualifies as incident to, and you cannot bill 99211. The physician will need to see the patient and bill the appropriate level of E/M.
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.
If the patient comes in for a procedure, ie blood draw or injection, you cannot code a 99211. However, if the patient comes in for a blood pressure check, you can.
Per CPT there is no requirement for History, Exam or MDM for a 99211 visit. All you really need to document is the chief complaint. Per CPT, "the presenting problem is minimal" and this service "may not require the presence of a physician."