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When to bill 99211 Service Provided Who Provided the care? Blood Pressure Check MA/CA LPN/RN Was Patient physically present and seen by MA/CA LPN/RN? Yes What was documented? Blood Pressure Check MA/CA LPN/RN S.McCormick,RMC,CPC 08/08 Yes Blood Pressure reading and any other pertinent vital signs. Clinical reason patient was being checked for blood pressure. Example: Pt here for abnormal or unstable blood pressure on new medications and doctor/provider requests weekly rechecks. Only Blood Pressure reading documented and nothing documented as indicated above to explain medical necessity. Was this tasked to provider for review and/or did provider make any recommendations? Should service a 99211 visit be billed? Yes, MA/CA/LPN/RN tasked this to provider. Provider reviewed and made any necessary recommendations for further treatment or advised that patient should continue current treatment etc. Provider did not physically see patient. Yes Why? Documentation clearly explains medical necessity of this service. Yes, MA/CA/LPN/RN tasked this to provider. Provider does nothing with this information nor requested it. No There is nothing to support medical necessity of the blood pressure check. When to bill 99211 Service Provided Who Provided the care? Blood Draw MA/CA LPN/RN Was Patient physically present and seen by MA/CA/LPN/RN? Yes What was documented? Blood Draw MA/CA LPN/RN Yes Glucose ck, or other in office labs MA/CA LPN/RN S.McCormick,RMC,CPC 08/08 Yes Was this tasked to provider for review and/or did provider make any recommendations? Pt here for lab blood draws only (usually only at Interfaith). No vitals or other services were provided or discussed. Pt here for lab blood draw and mentions they have had other symptoms. MA/CA/LPN/RN takes vitals and notes any other information patient reports. This is tasked to provider for review. Document results and task to provider. Should service a 99211 visit be billed? Yes, MA/CA/LPN/RN tasked this to provider. Provider simply notes, signs off on documentation. No Bill for blood draw only. There is not documentation to support billing a 99211 in addition to the blood draw service. Yes, MA/CA/LPN/RN tasked this to provider. Provider notes and makes any recommendations for patient but does not physically see patient. Provider tasks instructions to MA/CA/LPN/RN to report to patient on provider’s behalf. Yes Provider reviews and signs off if normal. If abnormal provider reviews and gives orders to CA/MA/LPN/RN for patient and this is carried out on behalf of provider and documented by MA/CA/LPN/RN. Normal with no other work involved. Only bill for test. Bill 99211 only and do not bill for blood draw since this is bundled into the 99211 service we are billing. Abnormal with other work involved and clearly documented, we can bill for test and 99211 visit. Billers would add modifier 25 to 99211 and a diagnosis of abnormal symptom test would be billed. When to bill 99211 Service Provided Who Provided the care? Was Patient physically present and seen by MA/CA/LPN/RN? Immunizations or Vaccines MA/CA LPN/RN Yes What was documented? Lead Screen Testing Lead Screen Testing MA/CA LPN/RN MA/CA LPN/RN Yes Yes S.McCormick,RMC,CPC 08/08 Was this tasked to provider for review and/or did provider make any recommendations? Pt here for any due vaccines including: Flu, pnemo, gardasil, tetanus, well child vaccines etc. Patient does not have any other needs. Patient did not have delay of vaccines due to illness, etc. Pt here for finger prick for Lead Screening to send to lab. Pt here for finger prick for Lead Screening to send to lab. While here patient mentions other symptoms, problems. MA/CA/LPN/RN takes vitals and notes any other information patient reports. This is tasked to provider for review. Should service a 99211 visit be billed? Yes, MA/CA/LPN/RN documents vaccines/immunizations provided and tasks this to provider. Provider simply notes, signs off on documentation. No Why? We bill for the administration portion of the vaccine with appropriate vaccine administration codes and therefore do not bill 99211 with this service. Yes, MA/CA/LPN/RN tasked this to provider. Provider simply notes, signs off on documentation. No Bill for blood draw (finger prick) only. Yes, MA/CA/LPN/RN tasked this to provider. Provider notes and makes any recommendations for patient but does not physically see patient. Provider tasks instructions to MA/CA/LPN/RN to report to patient on provider’s behalf. Yes Bill 99211 only and do not bill for finger prick specimen is bundled into the 99211 service we are billing. When to bill 99211 Service Provided Who Provided the care? Was Patient physically present and seen by MA/CA/LPN/RN? Immunizations or Vaccines MA/CA LPN/RN Yes What was documented? S.McCormick,RMC,CPC 08/08 Pt here for any due vaccines including: Flu, pnemo, gardasil, tetanus, well child vaccines etc. Patient did not have service provided at previous visit due to fever or other symptoms. Patient back for service today, MA/CA/LPN/RN checks vitals and documents symptoms are no longer a problem. MA/CA/LPN/RN provides Immunizations/vacci nes and also documents vitals and that pt is no longer having previous symptoms that caused vaccines to be delayed. Was this tasked to provider for review and/or did provider make any recommendations? Yes, MA/CA/LPN/RN documents vaccines/immunizations provided and tasked this to provider. Provider simply notes, signs off on documentation. Should service a 99211 visit be billed? Yes Why? Documentation clearly explains medical necessity of screening patient by taking vitals, and making sure patient was symptom free and safe for vaccines due to being ill previously. (Vaccines were not delayed due to convenience issue, parental concerns, vaccine not being in stock, etc.). In this case only would we go ahead and bill a 99211 with vaccines and vaccine administration since we can support medical necessity of a 99211 visit. A modifier 25 would need to be amended to the 99211 visit by billing staff showing a separately necessary service was provided in addition to vaccines. The diagnosis code for 99211 would be follow up for abnormal symptom that existed at previous visit to cause delay. When to bill 99211 Service Provided Who Provided the care? Prescription Refill MA/CA LPN/RN S.McCormick,RMC,CPC 08/08 Was Patient physically present and seen by MA/CA/LPN/RN? No What was documented? MA/CA/LPN/RN tasks request to provider. Was this tasked to provider for review and/or did provider make any recommendations? Provider approves refill and eprescribes, e-faxes script. Should service a 99211 visit be billed? No Why? Patient must be physically seen by a provider or a MA/CA/LPN/RN and medical necessity must be clearly documented. When to bill 99211 Prescription Refill MA/CA LPN/RN Yes Service Provided Who Provided the care? S.McCormick,RMC,CPC 08/08 Was Patient physically present and seen by MA/CA/LPN/RN? Pt requesting refill of medication for chronic condition. While talking to patient, patient mentions they have felt abnormal symptoms. Nurse documents and takes vitals, tasks to provider. What was documented? Provider reviews request and abnormal symptoms, vitals, etc. Provider makes recommendations for patient and also e-prescribes medication or e-faxes meds. Provider tasks MA/CA/LPN/RN with instructions for patient. MA/CA/LPN/RN accept task and communicates provider’s recommendations to patient. In this case a 99211 visit could be billed. Was this tasked to provider for review and/or did provider make any recommendations? Should service a 99211 visit be billed? Why? Pt was physically seen Pt had a medically necessary issue that was addressed. MA/CA/LPN/RN documented problem/vitals and tasked provider who responded with orders and MA/CA/LPN/RN acted on behalf of provider to assist patient. When to bill 99211 PPD/TB skin test MA/CA LPN/RN Yes PPD/TB skin test follow up for results MA/CA LPN/RN Yes Service Provided Who Provided the care? S.McCormick,RMC,CPC 08/08 Was Patient physically present and seen by Patient here only to have PPD skin test. MA/CA/LPN/RN only provides PPD/TB Skin Test Patient here only to have PPD skin test read. MA/CA/LPN/RN checks skin area where PPD/TB Skin test was provided. Results are documented as normal. Patient advised of signs/symptoms that could indicate TB. If results are documented as abnormal. Patient advised of signs/symptoms that could indicate TB. This information documented and tasked to provider. Provider gives orders (refer to TB Clinic, etc.). What was documented? Test documented and tasked to provider. Provider simply notes, signs off on documentation. No Why? Because the only service provided was the skin test and there is no medical necessity supported to bill a 99211 visit in addition to this test. Results of test documented and tasked to provider. Provider simply notes, signs off on documentation. In the case of abnormal provider would document instructions for patient that MA/CA/LPN/RN would convey to patient and document, etc. Debatable….. Why? Some insurance carriers feel this should be considered part of the PPD skin test charge. Others (providers/clinic/billers) feel if we have documentation to support that we physically reviewed site, counseled pt on other signs/symptoms to be aware of related to TB, etc. that we can support medical necessity and bill a 99211 for this service. A diagnosis of ppd skin test as well as patient education would help support billing 99211 for a normal PPD skin test reading. Was this tasked to provider for review and/or did provider make any recommendations? If abnormal diagnosis should be abnormal PPD skin test We would not bill TB since an abnormal test does not indicate the patient has TB it only confirms exposure to TB. Should service a 99211 visit be billed? When to bill 99211 Occult Blood Test (Fecal blood test assay) MA/CA LPN/RN MA/CA/LPN/RN? Yes Document results and task to provider. Provider reviews and signs off if normal. If abnormal provider reviews and gives orders to CA/MA/LPN/RN for patient and this is carried out on behalf of provider and documented by MA/CA/LPN/RN. Normal with no other work involved we would not bill 99211. If the test is provided on the same day, bill 82274-QW only with the provider’s E&M. This would be a time of service charge (1-3 simultaneous determinations done at time of service). If the patient does the test at home and brings back the specimen care, we should bill for the test only and do that only when pt comes back in with samples. If the test is abnormal with other work involved and clearly documented, bill for test unless provided on a separate day without a provider visit and then you may bill a 99211 visit. Service Provided Who Provided the care? S.McCormick,RMC,CPC 08/08 Was Patient physically present and seen by MA/CA/LPN/RN? What was documented? Was this tasked to provider for review and/or did provider make any recommendations? Should service a 99211 visit be billed? When to bill 99211 Suture Removal MA/CA LPN/RN YES That sutures were removed, wound adequately healed. Sutures provided by ER or another provider. Provider reviews and signs off. Yes. We would bill 99211 since there is no code for suture removal and since we didn’t put in the sutures it is a separate service from any surgical or wound care. A diagnosis of suture removal and wound care, etc. should be added for billing. Therapeutic injections B12 Depo Provera, allergy injections Etc. MA/CA LPN/RN Yes Document the therapeutic injection and what was provided. Provider reviews and signs off. We do not bill a 99211 with these since we are billing the administration for this service only. We bill for medication too unless pt brings in their own then we only bill administration. Should patient complain of other symptoms or concerns that you need to address with a provider and can document clear separate medically necessary care was provided, a 99211 would be billed and the medication only (if we provided medication). S.McCormick,RMC,CPC 08/08 When to bill 99211 Service Provided Who Provided the care? Weight Checks MA/CA LPN/RN S.McCormick,RMC,CPC 08/08 Was Patient physically present and seen by MA/CA/LPN/RN? Yes What was documented? Patient here for weight check as ordered by _____(Provider) on _____ (date). Current Weight is: ________. Patient asked if they had any questions regarding diet, etc. (if on special diabetic for a medical problem). Was this tasked to provider for review and/or did provider make any recommendations? Provider reviews and signs off if normal/okay. If abnormal (overweight/underweight) provider reviews and gives orders to CA/MA/LPN/RN for patient and this is carried out on behalf of provider and documented by MA/CA/LPN/RN Should service a 99211 visit be billed? Yes as long as the provider did not see the patient that day.
