CPT Code 99211 Nurse Visits | CPT Coding Tips

CPT Code 99211 Nurse Visits | CPT Coding Tips



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CPT Code 99211 Nurse Visits | CPT Coding Tips

Q: “Can someone please discuss 99211 CPT Code?

A: Why, sure, we can. Unlike Alicia, I wanted Chandra to do my answer sheet because I always have best intentions but normally the Thursday of the webinar we’re all running around and I’m like, “Last minute Laureen,” and it’s a very bad habit. At any rate, answer prepared by Chandra, presented by Laureen but it’s a real quickie so we’ll get right to your chat questions.

First of all, what’s the definition of 99211? We’ve got our new patient codes and we’ve got our established patient codes for evaluation and management. The 99211 is the first code for established outpatient but it’s very unique. It doesn’t have the common three bullets – history, exam and medical decision making – like you see with the other codes and it’s often referred to as the nurse visit code.

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More Information about CPT Code 99211:

Understanding When to Use 99211 – Family Practice Management

American Academy of Family Physicians
Using CPT code 99211 can boost your practice’s revenue and improve documentation. … However, one notable exception to this is CPT’s level-I established patient encounter code, 99211. CPT defines this code as an “office or other outpatient visit for the evaluation and management …

Clarification for use of 99211 code » Office of Physician Billing …

University of Florida College of Medicine
When 99211 is bi

Evaluation and Management Coding – Wikipedia, the free encyclopedia

Wikipedia
Evaluation and management coding is a medical coding process in support of medical billing. … E/M codes are based on the Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA). In 2010, new …

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Q: “Can someone please discuss 99211 CPT
Code? A: Why, sure, we can. Unlike Alicia, I wanted Chandra to do my answer
sheet because I always have best intentions but normally the Thursday of the webinar we’re
all running around and I’m like, “Last minute Laureen,” and it’s a very bad habit. At any rate, answer prepared by Chandra, presented
by Laureen but it’s a real quickie so we’ll get right to your chat questions. First of all, what’s the definition of 99211? We’ve got our new patient codes and we’ve
got our established patient codes for evaluation and management. The 99211 is the first code for established
outpatient but it’s very unique. It doesn’t have the common three bullets
– history, exam and medical decision making – like you see with the other codes and
it’s often referred to as the nurse visit code. Here’s the definition: 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 healthcare professional. Usually the presenting problem(s) are minimal. Typically, five minutes are spent performing
or supervising these services. So, the not requiring a physician is why they
call it a nurse visit code. Generally, it’s often ancillary nursing
staff that’s going to be providing the services during the encounters and it is an E/M service,
so there is some HEM going on – history, exam, medical decision making. But CPT doesn’t specify which areas or the
amount like they do with other codes where they have discrete levels of history, exam
and medical decision making. Medicare places further restrictions on reporting
99211by lumping it into the types of services typically performed “incident to” the
physician’s services. What that means is under the “incident to”
practice the physician must have established the plan. So, it’s not the nurses just taking over
and treating the patient. The physician has established the plan and
the nurses during follow-up in relation to that. So, that’s what that “incident to” is
talking about and there has to be direct supervision. It means the physician has to be immediately
available in the office suite to take over care should the need arise. There must be a documented need for the services
provided and the ancillary staff may not address any new problems or change any portion of
the plan of care and order for the service to be considered “incident to.” The physician must also periodically see the
patient – that would be nice. Some insurance carriers further specify this
by defining “periodically” as at least every third visit. So, if a patient is coming in for a routine
thing that the doctor is aware of, he has established the plan, he’d say, “OK, poke
your head in every third visit just to make sure everything’s going well.” The types of services typically provided during
these encounters are evaluation and management services considered minor in nature that do
not meet any other code definition, such as blood pressure checks, weight checks, etc. Some providers feel it is appropriate to report
a nurse visit (99211) in addition to venipunctures, immunizations, etc. However, most insurance carriers will deny
these… they will bundle them together. The reason is, for immunizations, the provider
is already receiving payment for the E/M portion of the service… or, in the case of the venipuncture,
the bundle the minimal E/M service provided into the payment for the venipuncture… They don’t want you to double dip. For more information on CPT® code 99211 and
nurse visits, here are a few articles and references that may be helpful. Again, advantage of being in the Replay Club,
you get all these links and benefits of our research. That was my quickie question on nurse visits
and thank you Chandra for doing that nice answer sheet for us.

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