Medicare Compliance & Reimbursement - 2014 Issue 4
Outpatient E/M: Embrace 99211 Regulations to Avoid Losing $20 per Encounter
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Article Overview
This article covers outpatient evaluation and management billing for established-patient encounters performed by nurses, physician assistants, and other non-physician professionals. It focuses on the general reporting criteria, documentation elements, and common situations where the service may or may not be separately reportable. The discussion is aimed at coders, billers, and clinic staff who handle office-based E/M documentation and reimbursement.
Why This Topic Matters
Correct handling of these low-level outpatient E/M encounters can affect reimbursement and reduce the risk of billing errors. The article helps readers understand the documentation themes and encounter types that are associated with this area of coding.
Article Sections
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Check the Code Criteria
This section reviews the general conditions discussed for reporting the outpatient established-patient visit code, including patient status, timing, and documentation themes.
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Avoid Using 99211 in Some Circumstances
This section outlines situations in which the article advises caution with reporting the code and emphasizes documentation and encounter-context considerations.
What You Will Learn
- How the article frames eligibility for reporting a low-level outpatient established-patient E/M visit
- What broad documentation elements are discussed for supporting a nurse or non-physician encounter
- Which general types of encounters the article says deserve caution in outpatient E/M reporting
- How the article connects documentation quality with reimbursement for office-based E/M services
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Clinic staff
- Nurses and other non-physician healthcare professionals
Codes Discussed
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