This encounter is coded as 99214 because it included:
- Detailed history: Extended history of present illness, extended review of symptoms, one personal family and social history;
- Comprehensive examination: Eight systems; and
- Medical decision making: Moderate complexity (established problem, new problem, no additional workup, and new prescription drug ordered).
CPT code: 20610—Major joint or bursa (i.e., shoulder, hip, knee joint, or subacromial bursa).
HCPCS Code: J7322—Hyaluronan or derivative, synvisc, for intraarticular injection, per dose.
Note: Keep in mind when a nurse practitioner (NP) or PA sees an established patient with a new problem and the physician does not perform an examination, the service will not be considered incident-to when billing Medicare. The NP/PA will have to bill this claim under his or her own National Provider Identification number. This will be reimbursed at 85% of the fee schedule. Physician offices will have to verify with individual third-party payers as to their reimbursement policy for nonphysician healthcare providers.
