Requiring an average of five minutes of time and none of the three key E&M components, code 99211 is typically used for basic or routine procedures. Because of its straightforward nature, this code does not even require the direct presence of a physician. This in turn has led many practices to refer to it as simply a nurse visit. However, despite its seemingly simple nature (or perhaps because of it), this code is actually one of the most misused.
No Medical Necessity
As with all codes, 99211 requires closely documented medical necessity in order to justify its usage. Though medical professionals use simple procedures such as BP checks in many patient interactions, not every encounter requires such readings. Unfortunately, some practices will tack these basic procedures onto unrelated ones, such as helping a patient take a routine medication. By adding the blood pressure reading, the practice believes it can now code a 99211 in order to receive reimbursement. In actuality, even these minor actions require documented physician approval to fulfill medical necessity.
No Face-to-Face Interaction
Another common mistake practices make is using 99211 to code for visits that are not face-to-face. Because of the language specifying that a physician may not be present, some healthcare professionals assume that phone conversations with patients qualify for this code. In reality, this is not the case; in fact, the official 99211 description states right off the bat that the code only applies to “office or other outpatient visit[s].”
Improper Staff Credentials
Say you’ve just finished a routine patient encounter which had documented medical necessity and took place in person. Everything should be in order to code 99211, right? Not necessarily—it depends on the credentials of the person who interacted with the patient. If the NPP is credentialed and has their own National Provider Identifier (NPI) number, then everything is good to go. If, however, the NPP is not certified, then the encounter must meet incident-to standards in order to go under the practicing physician’s NPI. This means that any patient visit leading to a new prescription or plan of care does not necessitate a 99211 unless it also fulfills incident-to guidelines.
All in all, code 99211 is often not as simple as it may seem at first glance. As with all matters, practices should make sure they take the time to code each encounter accurately in order to maintain the highest level of satisfaction and compliance.