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.
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Explore This IssueJuly 2008
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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.
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.