Coding for a Nurse-Patient Encounter

Article excerpt

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

A: A patient encounter with a nurse does not mean you can automatically bill using code 99211. Even though the documentation requirements for 99211 are less stringent than for most other E&M services, documentation is still required.

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."

Keep In mind that there are many instances when a nurse's services would more accurately be reported utilizing another CPT code, such as an injection or venipuncture code.

Even though 99211 does not require the same documentation (i.e., history, examination, or medical decision making) as the higher-level established patient visits (99212-59215), 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:

* Did the nurse provide a medically necessary E&M service?

* Was the nurse encounter face-to-face?

* Is the patient established? (The code cannot be used for a new patient)

* Can the service provided be described by another CPT code?

* Did the physician initiate the order for the nurse's evaluation, and was the physician in the office suite while the nurse provided the service for Medicare patients and patients of private payers who have similar policies?

* Was the reason for the visit and a description of the service rendered documented?


Q: School is about to start again, and that means a number of my younger patients will come in for sports physicals. …