billing nurse visit 99211 with pt/inr

Can anyone clarify for me the guidlines surrounding billing a 99211 for a nurse visit when the patient comes in for inr check? We have practices that feel they can "blanket" charge this E/M for all pt's coming in for inr check. With 13 provider based practices under our umbrella, I would like to draft a policy so we have consistency once and for all with this issue.

re: billing nurse visit 99211 with pt/inr

A nurse visit can only be charged if an abnormal result and physician is contacted for advice. Ask yourself: Was there a change in medical treatment as a result of this visit?, Was the patient physically in your office? Was the visit pertaining to a service that was medically necessary? If "yes" to these questions, then may be able to charge 99211. example: The doctor's nurse performs the PT/INR test and shows the doctor the results of the test while that patient is still in the office. The PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT® 99211 coding. BUT, The same patient comes into your office for a routine PT/INR test. Doctor is in the office at the time of the visit, meeting the first requirement for CPT® 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT® 99211 are not being met and you will not be able to use this code for billing for this visit.

re: billing nurse visit 99211 with pt/inr

Guidelines & examples here: http://www.trailblazerhealth.com/Publications/Job%20Aid/DocReqCPT99211JobAid.pdf

re: billing nurse visit 99211 with pt/inr

Hate to say but I disagree with Nancy. there does not have to be a change in dose to bill 99211. As it says: Alternatively, for patients who have no new clinical concerns, documentation that contemporaneous laboratory values were obtained, reviewed, and used to guide current and/or future therapy documents that a separately payable E/M service has been performed.

We get a set of vitals, review meds, ask about bleeding/ bruising, get the INR, review result with MD and if needed change dose. The MD reviews and signs the note and we bill 99211

re: billing nurse visit 99211 with pt/inr

http://www.magmutual.com/mmic/articles/Coumadin.pdf