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Patency Capsule

Heidi Posted Wed 20th of August, 2014 12:40:29 PM

I am looking for some guideance on billing for Patency Capsules. We bill with the 91299 for the capsule and the interpretation of the radiology report. One of my physicians states he was told we can also bill a 99211 for the nurses time instructing the patient and giving the patient the capsule to swallow. Do you have any documentation guidelines or suggestions on billing the E&M visit with the patency capsule?

SuperCoder Answered Wed 20th of August, 2014 14:10:07 PM

Thanks for your question. You should not bill a 99211 with this code unless it represents a minimal level of evaluation and management. If the nurse is just spending time providing the capsule that is part of the procedure. If you find that there is a separate and significant reason to complete an evaluation and management service, append modifier 25 with 99211. Modifier 25 represents significant, separately identifiable Evaluation and Management service by the same physician or other qualified health care professional on the same day of the procedure or other service. Unfortunately, we do not have any publications or articles on our site for this type of service in conjunction with an E/M. Also make sure that there is adequate documentation for billing 99211. Hope this helps.

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