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99211

donna Posted Fri 16th of August, 2019 11:51:42 AM
We have a CMA provide instructions for Home Sleep Study - equipment usage. She is onsite with the LNP. The CMA provides the equipment demonstration and documents visit for the study and instructions on use. We have appropriate documentation for the visit and believe this will qualify for the 99211 (office visit w/o physician). We believe there would be no need for a modifier showing separate visit for the home sleep visit. Need you to verify assumptions are correct. We want to ensure this is separate and billable. This is for SLEEP STUDY. I did not see this criteria in your coding sections so I selected Family Practice.....
SuperCoder Answered Mon 19th of August, 2019 09:56:43 AM
Hi,
 
Our team is working on it. We will get back to you soon.
 
Thanks
SuperCoder Answered Tue 20th of August, 2019 09:50:15 AM

Hi,

 

According to CPT manual, 99211 is used when an established patient receives an evaluation and management service, typically for 5 minutes, that does not necessarily require a physician or other qualified health care professional to see the patient. All nursing staff (RNs, LPNs, CMAs) are eligible to use the 99211 code. Services provided by RNs, LPNs and CMAs must be those that fall under the scope of care as stated by their individual licensing requirements.

 In above mentioned scenario, CMA is providing instructions for home sleep study equipment usage and it qualifies for the use of CPT 99211.

 

Please also check below links:

https://www.supercoder.com/coding-newsletters/my-primary-care-coding-alert/insert-sample-99211-policy-a-article

https://www.supercoder.com/coding-newsletters/my-primary-care-coding-alert/insert-sample-99211-policy-b-article

 

Thanks

SuperCoder Answered Tue 20th of August, 2019 09:50:50 AM

Thanks.

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