Coding, Classification and Reimbursement

Billing 99211

  • 1.  Billing 99211

    Posted 7 days ago
    Hello,

    We are having a debate in our office about billing 99211. An established patient comes in and is taken back to the room, they are weighed, vitals taken, etc. Unfortunately, the physician is running extremely behind and the patient gets upset and leaves. Can we bill for a nurse visit-99211 if the patient leaves without being seen?


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    Dana Collar, RHIT
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  • 2.  RE: Billing 99211

    Posted 6 days ago
    Good morning Dana,

    May I ask what was the reason for the visit ? Was this a scheduled or walk in visit?  What icd-10 code is being assigned ?

    The below is from Medicare guidance. Medicare also provides a 99211 checklist.

    Evaluation  and Management Services

    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.




    • Blood pressure checks
      • Blood pressure checks that have not been ordered by the physician for a specific reason. Simply taking the patient's blood pressure on the day the patient presents for a test does not allow the practice to bill 99211 for the nurse's time.
      • The use of 99211 depends on whether there are clinical indications for the visit. Procedure code 99211 should not be reported for the stable patient who decides to come in for a blood-pressure check while in the area.


    Hope the above helps.

    Have a great day,

    Julie

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    Julie Pisacane CCA,CPMA ,CPPM,CEMC
    Billing and Coding Specialist
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  • 3.  RE: Billing 99211

    Posted 6 days ago
    Hi Julie,
    The reason for the visits are previously scheduled follow up visits for established patients. There isn't an ICD10 code being used...that is what I'm trying to tell my provider. He seems to think we are able to bill when a patient leaves once they are taken back to the room and vitals are done. He says we can use the reason for the visit and/or chronic conditions as ICD10 codes. I'm trying to tell him we can't, but he is adamant. I just wanted to make sure I was 100% correct before I stand my ground.

    Thank you for your help!

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    Dana Collar, RHIT
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  • 4.  RE: Billing 99211

    Posted 6 days ago
    You are welcome. I am glad you posted the question because 99211 often gets misused. It was good for me to review scenarios of when and when not to bill this code.

    Best,

    Julie

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    Julie Pisacane CCA,CPMA ,CPPM,CEMC
    Billing and Coding Specialist
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  • 5.  RE: Billing 99211

    Posted 6 days ago
    We have done that in the past, we have received payment before.  We always ask the patient if they want to make an appointment to come back.  We found when we do that, it is the nurses time we are charging for.  

    Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist.