Selina Posted Wed 11th of March, 2020 20:32:39 PM
Hello, Could you please provide details about billing low level office visits (99211) with any breath tests, genetic testing, or immunohemoccults that are performed in office? Is the only requirement that vital signs are obtained and noted? Does the office visit need a diagnosis and plan? Will this OV create a copay for the patient? What about OV with infusion visits - are these standard? Thank you!
SuperCoder Answered Thu 12th of March, 2020 10:47:54 AM
Thanks for your question.
Code 99211 is reported 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.
For 99211, the provider, often a nurse, spends an average of 5 minutes face–to–face with an established patient. This service does not require a physician or other qualified healthcare provider, such as a physician assistant, to see the patient. The presenting problem is typically minimal.
You might need to be careful reporting an office visit and the breath test on the same day. You can report an E/M code only if the physician's documentation supports that the E/M service meets the medical necessity and was more than just the administration and/or analysis of the diagnostic test. In other words, you cannot report an E/M service (such as 99211, Office or other outpatient visit ...) if the patient is merely taking the breath test.
If another CPT code more accurately describes the service being provided, that code should be reported instead of 99211. For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not 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 needs to include reason for encounter, any relevant history, physical assessment and plan of care.
If the patient presented for just an injection or to pick up a prescription, and nothing else was performed, reviewed, or discussed, a 99211 is not appropriate.
Please feel free to ask if you have any questions.
Selina Posted Thu 12th of March, 2020 10:59:56 AM
Thank you. The patient will incur a copay once the OV is billed, correct? What about OV routinely billed with infusions?
SuperCoder Answered Fri 13th of March, 2020 06:30:05 AM
Thanks for your question.
The patient will most likely incur a copay as code 99211 is subject to most of the rules pertaining to copay, coinsurance, and out of pocket maximums.
When infusion or chemotherapy is administered on the date of service, then code 99211 should not be reported in Medicare patient.
Hope this helps.