Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Coding Tip: When To Use 99211

From the College  |  Issue: July 2008  |  July 1, 2008

Many rheumatology practices don’t know when to bill the nursing code 99211. Because of this confusion, some practices shy away from using it at all, and some overuse it.

The official definition of this code in the CPT 2008 is, “for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.” Still, many physicians are confused about when and why they should use this code.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The following guidelines will aid you and your staff in determining when a service meets the qualifications for 99211:

  • The patient must be established: A patient is considered established if he or she has received any professional service from the physician—or any other physician of the same specialty in the same group practice—within the past three years.
  • The encounter with the patient must be face-to-face: This rules out telephone calls with patients.
  • An evaluation and management service must be given: The patient’s history should be reviewed and a limited assessment, or some level of medical decision-making, should be made. If no clinical need is shown, 99211 should not be billed.
  • The presenting problem only has to be minimal: This would include procedures such as reading the result from a tuberculosis skin test or drawing blood for lab work.
  • The code cannot be used with the following: Any drug administration code or for the use of administration of any immunization.

Although the guidelines for billing the 99211 are somewhat restrictive, practices can—and should—take advantage of this revenue whenever possible.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

If you have any further questions, contact Melesia Tillman, CCP, CPC, at [email protected] or (404) 633-3777, ext. 820.

Test your knowledge of the code 99211. Read this month’s “Coding Corner”.

Share: 

Filed under:Billing/CodingFrom the CollegePractice Support Tagged with:BillingCoding

Related Articles

    A New Era of Coding Evaluation & Management Services

    January 25, 2021

    After 25 years, the American Medical Association (AMA) Current Procedural Terminology (CPT) office and outpatient evaluation and management (E/M) codes received a major overhaul. These changes, which went into effect Jan. 1, will help reduce administrative burden on providers and roll back some of the rigid requirements for E/M coding by simplifying the code selection…

    10 Tips to Master E/M Coding Changes

    May 5, 2021

    Learn to properly use the revised CPT codes to document your time and medical decision making during patient visits to help ensure your practice is appropriately remunerated.

    Prepare NOW for ICD-10 Medical Coding Transition

    Prepare NOW for ICD-10 Medical Coding Transition

    July 14, 2015

    The ICD-10 page on the Centers for Medicare & Medicaid Services (CMS) website features a countdown clock that shows the time left until Oct. 1, 2015, the date on which compliance with the new code set becomes mandatory. By the time this issue goes to press, the clock will read 90 or fewer days. Time…

    An ‘Idea Factory’ Focused on Patient Care

    February 12, 2011

    Trish Cornell, BSc, combines clinical and leadership skills to improve patient management

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences