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Explore This IssueJuly 2008
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If you chose Scenario 1 you are correct!
This scenario involves minimal face-to-face time with the patient, and includes some type of assessment or medical decision-making. The visit is with the nurse, therefore the 99211 is allowed, and the 86580 is for the tuberculosis skin test.
Scenario 2 should have been coded 90772, “therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular” and J1600 for the medication. The 85025 is for the complete blood count; the 85031 is for the platelet count; and the 81000 is the urine dip test. The nursing code cannot be billed in this scenario because 99211 cannot be billed with any drug administration codes.
In Scenario 3, 99211 could not be billed because there was no face-to-face encounter between the patient and the nurse. A non–face-to-face, non–physician services code should be used instead. They are 98966, which is used for “Telephone assessment and management service provided by a qualified non-physician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within with previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion,” 98967, which is used for, “11–20 minutes of medical discussion,” and 98968, which is used for, “21–30 minutes of medical discussion.”
See page 18 for more information about using code 99211.