Coding for a nurse-patient encounter

August 7, 2009

A patient encounter with a nurse does not mean you can automatically bill using code 99211.

Key Points

Q: Can we bill using CPT code 99211 when a nurse sees a patient in our primary care office?

The 2009 CPT manual defines 99211 as an "office visit or other outpatient visit for the evaluation and management of an established patient, that may require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services."

Even though 99211 does not require the same documentation (i.e., history, examination, or medical decision making) as the higher-level established patient visits (99212–99215), there does need to be documentation to substantiate that the nurse evaluated and/or managed the patient. This could include the reason for the visit, a brief history, vital signs, and/or a brief assessment. A standard office policy to take vitals before regularly scheduled injections, such as B-12, for example, does not constitute a 99211 service.

Here are some questions to ask before billing 99211:

The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Have a coding or managed care question for our experts? Send it to meletters@advanstar.com
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