CPT Code 99211 For An Office Visit

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CPT Code 99211 For An Office Visit
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CPT Code 99211 For An Office Visit

• The requirements for most evaluation and
  management codes have become more accurate over
  the past few years. However, one prominent
  exception to this is CPTs level-I established
  patient encounter CPT Code 99211 for an office
  visit. CPT defines this code as an office or
  other outpatient visit for the evaluation and
  management of an established patient that may not
  require the presence of a physician. It further
  states that the presenting problems are usually
  minimal, and typically five minutes are spent
  performing or supervising these services. Yet
  many physicians still confuse with when or why to
  report this code. This article describes how
  appropriately reporting 99211 can improve revenue
  and documentation, and provides specific
  guidelines and examples that can help physicians
  identify appropriate uses for the code.
• Basic Guidelines for CPT Code 99211
• The following guidelines can help you decide
  whether a service qualifies for 99211
• The provider-patient encounter must be
  face-to-face. For this reason, telephone calls
  with patients do not meet the requirements for
  reporting 99211
• The patient must be established. According to
  CPT, an established patient is one who has
  received professional services from the physician
  or another physician of the same specialty in the
  same group practice within the past three years.
  Code 99211 cannot be reported for services
  provided to patients who are new to the physician

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CPT Code 99211 For An Office Visit

• An E/M service must be provided. Generally, this
  means that the patients history is reviewed, a
  limited physical assessment is performed or some
  degree of decision making occurs. If a clinical
  need cannot be substantiated, 99211 should not be
  reported. For example, 99211 would not be
  appropriate when a patient comes into the office
  just to pick up a routine prescription
• The service must be separate from other services
  performed on the same day.
• Services that are considered part of another E/M
  service provided on the same day should not be
  reported with code 99211. For example, if a nurse
  provides instructions following a physicians
  minor procedure or takes a patients vital signs
  prior to an encounter with the physician, 99211
  should not be reported for these activities
  because they are considered part of the E/M
  service already being provided by the physician.
• New Prolonged Services CPT Code
• A new prolonged services code (with or without
  direct patient contact) has been created to
  describe a prolonged office and outpatient EM
  service of 15 minutes beyond the total time of
  the primary EM procedure. It can only be
  reported when the EM service has been selected
  based on time alone (not medical decision making)
  only after the total time of a level 5 service
  (either 99205 or 99215) has been exceeded.

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CPT Code 99211 For An Office Visit
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