When is it Proper to Bill Nurse Visits using 99211

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS

When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit where vaccines are administered is not always understood. The answer depends on whether the provider performs a medically necessary and significant, separately identifiable E/M visit, in addition to the immunization administration.

CMS states, when a separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to drug administration services, you should report the appropriate E/M CPT code, reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.

It is incorrect to bill a 99211 when the provider provides an E/M service that meets a higher complexity level than CPT code 99211, you must bill the higher complexity, and you cannot bill for two services in one day. 

Charging for Nurse Visits

There are times when it is appropriate to report for a nurse visit using CPT code 99211. The Incident-to rule applies when reporting this code, and services provided must be documented as medically necessary services, including the clinical history, clinical exam, making a clinical decision, and physician supervision. 

When reporting CPT codes 90782, 90783, 90784, or 90788, CPT code 99211 cannot be used; it is improper billing to report a visit solely for the purpose of receiving an injection that meets the definition of the injection codes. 

When the only reason for the visit is for the patient to receive an injection, payment may be made only for the injection (if it is covered). An office visit using 99211 would not be warranted where the services rendered did not constitute a regular office visit.

Unlike other E/M codes 99202-9920599212-99215, time alone is not to be used when reporting 99211 when selecting the appropriate code level for E/M services. Effective January 1, 2021, time was removed as an available code-selection criterion. The typical time spent on this code is five minutes.  

Other visits that may be billed with 99211

There are several other visits that may be reported using 99211, and nurses are not the only staff that can report this code; medical Assistants and technicians are also included under non-physician.  

Covid-19 Testing

According to CMS; Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection for Covid-19 incident to the billing professionals services for both new and established patients. When the specimen collection is performed as part of another service or procedure, such as a higher-level visit furnished by the billing practitioner, that higher-level visit code should be billed, and the specimen collection would not be separately payable.

Examples from CMS

The following are examples of when CPT 99211 might be used:

References:

When is it Proper to Bill Nurse Visits using 99211. (2021, August 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/nurse-visits-and-injections-36866.html

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