Forum - Questions & Answers

Nov 21st, 2011 - colleent

99211 E & M: INR POC Visit

I've heard that in the last year the OIG started investigating clinics for incorrectly charging the 99211 code (example: large clinic brings in patients once a month for Coumadin testing & bills the E & M). I understand that the E & M can only be billed if there is a "dosing" change or if there are other issues and cannot be billed if the patient is in range & there are no additional problems.

Is there any documentations or articles on the audits?

Nov 29th, 2011 - vsmichael 20 

re: 99211 E & M: INR POC Visit

I only code the 99211 if the nurse documents the results, the discussion with the physician and if there was a dosage change based on the results. If only the test and results were documented with no mention of any discussion with the doctor or a dosage change, I only code the 85610.

Nov 30th, 2011 -

re: 99211 E & M: INR POC Visit

As I understand it, even though 99211 doesn't have the same documentation requirements as higher-level E&M, it's still a charge for face-to-face evaluation & management of a patient's condition.

The Trailblazer MAC identifies the following as sufficient to charge for a 99211:

- e.g., for blood pressure check, IF clinical signs indicating need for bp check are documented, vital signs and medications (along with compliance) are documented, and the physician's clinical evaluation of this information along with his recommendation for management are documented.

- e.g., for coumadin check, IF significant clinical signs (e.g. bruising) or review of contemporaneous lab results are documented, current medications and compliance are documented, and the physician's clinical evaluation of this information along with his recommendation for management are documented.

(source: http://www.trailblazerhealth.com/Publications/Job%20Aid/DocReqCPT99211JobAid.pdf)

Pinnacle MAC suggests something similar (p.32):

http://www.compliance.lsuhscshreveport.edu/Microsoft_PowerPoint_-_Part_B_Medical_documentation_guidelines_webinar_1-22-09_final_LL_1_.pdf

Personally, I'd be leery of billing 99211 for straightforward in-and-out visits for injections, blood draws, etc. if there was no obvious evaluation or management component there. Pinnacle actually states in their guidance that, if you can bill the service under some other code, you shouldn't use 99211.

Dec 1st, 2011 -

re: 99211 E & M: INR POC Visit

Note that Trailblazer does not require that there be a dosage change. Don't make it more onerous than required.



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