Coding > Coding
code 99211
catooch:
Hi. I work for a chiropractor and I heard that you can bill 99211(office visit) if the patient did not get adjusted and received only therapy. Does anyone know what the guidelines to this code is pertaining to chiropractors.
Thank you.
DMK:
You can bill a 99211, but many insurance companies no longer pay on this code. It's an evaluation and management code and your records would have to show the doctor discussing the case with the patient and then administering the therapies. Using a -25 modifier indicates that it was an ACTUAL eval and management and the records should reflect that.
You can't just bill for an office visit just because the patient showed up for therapy.
If the doctor palpates the region but doesn't adjust you can bill the 98940, 98941, 98943 with a -52 modifier showing a reduced service (the region was checked, but an adjustment wasn't needed or performed).
Billergirlnyc:
I just want to add another note about how/why 99211 is used, and how many carriers see the code.
It's actually a code that is "intended" for a provider to use when his/her ancillary staff sees a patient and they are in the office (I tend to follow MC's guidelines on incident-to, etc}. For example if a nurse sees the patient to say check blood pressure, or an MA, or tech, examples: A blood pressure evaluation for an estab patient, refilling meds, follow up PPD/tuberculin test reading, Suture removal. etc. Anything that doesn't require the physician. This doesn't apply to a NPP/PA, because they're considered providers, but a regular RN, MA, tech, etc this applies too them, this being 99211. This doesn't mean that NPP/PA can't bill for it, but again I'm only pointing-out how the code is seen and often used.
There are also codes you shouldn't bill w/a 99211 like blood draw, injections, etc, and there have been plenty debates about this too, many of them will point to carrier to carrier rules. Some carriers will pay it, some won't. There are no hard and fast rules w/this but you might want to research this code a bit more to understand how it's often used. I know of a lot of carriers who actually refer to 99211 as "nurse visits", but this doesn't mean the Physician can't bill for it, again it's just looking at how it's often billed and when. If you re-read the CPT definition for this code it also explains that 99211 "may not" require the presence of a physician — again just to further help how some carriers see the code, and why some won't pay for it.
And, as it's been stated, you really should only use 99211 for a significant separately identifiable service, like all E/M's. If you can separate the E/M service from say a vaccination then you can safely bill 99211, and the documentation must support it.
If a patient was scheduled for therapy as DMK stated you can't just bill for an E/M because the patient was scheduled for the therapy, there needs to be more going on, again see above --->"significant separately identifiable service" <---.
Sorry for going on a tangent, but this code use to be the bane of my existence, especially when I tried to explain it to my doctors. I will try to find some links that have helped me understand it more.
Here is one link I've used for one my Pulmonlogist when explaining this code. http://www.supercoder.com/articles/articles-alerts/puc/reporting-pneumo-vaccines-keep-99211-separate/
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