Revenue Cycle

Q/A: Proper assignment of code 99211

APCs Weekly Monitor, June 5, 2009

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Q: Can we bill 99211 for nursing services provided in a clinic when no physician is present in the room? The full description of 99211 indicates physician presence may not be required.
 

A. The CPT statement about presence of a physician isn’t applicable to hospitals and proper assignment of the code depends on the services provided and the hospital’s own coding criteria. CMS has instructed hospitals to go with their own hospital developed criteria for assignment of levels for E/M codes.

For the facility portion of a visit where only the nurse saw an established patient and the physician was not present in the room for the visit, the hospital may bill 99211-99215 depending on the hospital’s criteria for assignment of levels. The physician need not see the patient for the hospital to bill a 99215, for instance, for the nurse’s services, as long as the services provided meet the criteria established by the hospital for that level.



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