RT Welter & Associates is excited to present our monthly Code Spotlight! Each month, RT Welter & Associates will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.
99211: 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.) is designated as the GO-TO Nurse/RN visit. In the majority of post-payment audits of 99211, the findings are conclusive – the code is widely misreported. The key to compliantly billing 99211 is that the documented face-to- face encounter must have an actual impact on the patient’s care. Merely doing a BP check, drawing labs, or administering an injection when the information obtained does not lead to management of a condition or illness, would not constitute a billable service. There should be clear documentation in the chart regarding patient/clinician exchanging medically significant and necessary information and there is management of the patient’s care via medical decision making (e.g. change in med regimen).