Unlock CPT 99211 Billing: When & how to use for Established patient

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Confused about when to code CPT 99211 for established patients? This guide clarifies its use, including “incident to” services, documentation tips, and more!

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Full Description

Code 99211 is often misunderstood or misused because it’s a low-complexity code primarily used for minimal nursing services and doesn’t typically involve the direct care of a physician or other provider.

The misuse of code 99211 can lead to improper billing practices and potentially audits by insurance companies or government agencies. It’s important for healthcare providers to accurately document and code their services to ensure proper reimbursement and compliance with coding guidelines.

Very little official documentation guidance has been published for CPT 99211. Unlike the other E&M codes, history, exam, and medical decision making are not required. However, CPT 99211 remains
an Evaluation & Management service and requires both evaluation AND management elements. CPT 99211 is defined by CPT as “Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

Additional information

Contributor

Michelle Anderson

Format

Article

Publication Date

01/08/2024

Source

CodeEMR