Hint: You can't automatically tack 99211 on to every service just because the nurse was present.
Most practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many MACs are scrutinizing these claims and targeting them as "areas of concern," as WPS Medicare did this past April. Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.
Know Whether 99211 Applies to X-Rays
Question 1: A patient comes to see the physician for a leg problem. The staff performs x-rays and then the patient waits in the exam room for the doctor, but gets a call and has to leave before she actually sees the physician. Does 99211 apply to this visit?
Answer 1: "What is unanswered is was the x-ray ordered by the doctor?" asks Ruby Woodward, BSN, ACS-OR, coding and research specialist at Twin Cities Orthopedics in St. Louis Park, Minn. "If the physician ordered and read it, bill the x-ray unmodified. If the physician did not order the x-ray, then nothing can be billed."
In short, Woodward says, you cannot report 99211 unless an actual evaluation and management service was provided.
Will 99211 Cover Vaccines?
Question 2: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?
Answer 2: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient or the patient has other diagnoses that the nurse goes over, then 99211 might be appropriate.
In some cases, depending on the CCI edits for the specific vaccine codes you're using, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211.
In black and white: "Services billed to Medicare under CPT code 99211 must be reasonable and necessary for the diagnosis and treatment of an illness or injury," says a policy on 99211 written by Part B MAC WPS Medicare.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/category/articles/articles-alerts/pbi/
Most practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many MACs are scrutinizing these claims and targeting them as "areas of concern," as WPS Medicare did this past April. Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.
Know Whether 99211 Applies to X-Rays
Question 1: A patient comes to see the physician for a leg problem. The staff performs x-rays and then the patient waits in the exam room for the doctor, but gets a call and has to leave before she actually sees the physician. Does 99211 apply to this visit?
Answer 1: "What is unanswered is was the x-ray ordered by the doctor?" asks Ruby Woodward, BSN, ACS-OR, coding and research specialist at Twin Cities Orthopedics in St. Louis Park, Minn. "If the physician ordered and read it, bill the x-ray unmodified. If the physician did not order the x-ray, then nothing can be billed."
In short, Woodward says, you cannot report 99211 unless an actual evaluation and management service was provided.
Will 99211 Cover Vaccines?
Question 2: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?
Answer 2: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient or the patient has other diagnoses that the nurse goes over, then 99211 might be appropriate.
In some cases, depending on the CCI edits for the specific vaccine codes you're using, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211.
In black and white: "Services billed to Medicare under CPT code 99211 must be reasonable and necessary for the diagnosis and treatment of an illness or injury," says a policy on 99211 written by Part B MAC WPS Medicare.
Like the article? Click here to read the entire article and to get access to our monthly Part B Insider newsletter.
http://www.supercoder.com/category/articles/articles-alerts/pbi/
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