99211 CPT Code Description
99211 CPT Code: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. Billing Instructions: Bill 1 unit per visit.
The following guidelines can help you decide whether a service qualifies for 99211:
- The patient must be established.
- The provider-patient encounter must be face-to-face.
- An E/M service must be provided. Generally, this means that the patient’s history is reviewed, a limited physical assessment is performed, or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. If another CPT code more accurately describes the service being provided, report it instead of 99211 (e.g., 36415 for a routine blood draw visit with a nurse).
- The service must be separate from other services performed on the same day. Services considered part of another E/M service provided on the same day should not be reported with code 99211 (e.g., a nurse checks a patient’s vital signs prior to an encounter with the physician).
- The presence of a physician is not always required. Although physicians can report 99211, CPT’s intent with the code is to provide a mechanism to report services rendered by other individuals in the practice. Medicare’s requirements are slightly different: The physician must have initiated the service as part of a continuing plan of care in which he or she will be an ongoing participant and must be in the office suite when the service is provided.
- No key components are required. Unlike other office visit E/M codes – such as 99212, which requires at least two of three key components (problem-focused history, problem-focused examination, and straightforward medical decision making) – the documentation of a 99211 visit does not have any specific key-component requirements. The note just needs to include sufficient information to support the reason for the encounter and E/M service and any relevant history, physical assessment, and plan of care. The date of service and the identity of the person providing the care should be noted along with any interaction with the supervising physician.
Average fee amount – $25 – $40
Who can Bill 99211 CPT Code
CPT Code 99211 is often called the nurse visit code. But it’s not just for nurses! Many of your practice employees can provide the service. They must be qualified to evaluate and meet the patient’s care needs in a limited capacity. That means, you can bill 99211 for a medically necessary, face-to-face established patient service performed by a healthcare professional including:
- Medical Assistant (MA)
- Certified Nurse Assistant (CNA)
- Licensed Practicing Nurse (LPN)
- Registered Nurse (RN)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Physician (MD)
Medicare will pay for medically necessary office/outpatient visits billed on the same day as a drug administration service with modifier -25 when the modifier indicates that a separately identifiable evaluation and management (E/M) service was performed that meets a higher complexity level of care than a service represented by Procedure code 99211.
Examples of 99211 Services
- A scheduled follow-up visit for weight check for a patient recently placed on a new medication known to cause weight gain
- A blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure
- Discussion with patient in-person following abnormal laboratory tests
- Suture removal following placement by a different physician/physician group
- Diabetic counseling that is non repetitive
- Dressing change for an abrasion/injury
Because some services are more appropriately reported with a CPT code other than 99211, because not every encounter has a clinical indication that supports a separate visit code and because some patients may balk at the idea of being charged for some 99211 services (such as a blood-pressure check) be cautious about establishing a practice of billing an E/M service with every staff encounter. Instead, use these guidelines and examples to determine the appropriate uses of 99211. Many Medicare carriers and other third-party payers periodically issue examples and guidelines regarding the proper use of certain codes. Staying knowledgeable about these coding practices can improve your practice’s reimbursement and reduce potential audit liability.
For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com