When to bill 99211

Service Provided / Who may provide this care? / Must patient be physically present and seen by MA/CA LPN/RN? / Documented the following in order to bill this service: / Follow up with tasking providerurgently for review and/or to make any recommendations. / Should service a 99211 visit be billed?
Blood Pressure Check / MA/CA/LPN/RN / Yes /
  • Blood Pressure reading and any other pertinent vital signs (Wt. and Pulse)
  • Clinical reason patient was being checked for blood pressure. (Check last note in eMR, etc.)
  • Example: Pt here for abnormal or unstable blood pressure on new medications and doctor/provider requests weekly rechecks.
Add a diagnosis of the following based on previous note by provider and order:
  • 401.9 Hypertension unspecified.
  • 401.1 Hypertension Benign
  • 401.0 Hypertension Malignant
  • 796.2 Elevated Blood Pressure without diagnosis of hypertension
/
  • MA/CA/LPN/RN must task this to provider.
  • Provider will review and make any necessary recommendations for further treatment or make recommendation for patient; continue current treatment etc.
  • Provider does not physically need to see patient but should be in the office. If ordering provider is not in office you need to task a provider who is working that day in the office.
/ Yes
Why?
Documentation clearly explains medical necessity of this service.
Service Provided / Who may provide this care? / Must patient be physically present and seen by MA/CA LPN/RN? / Documented the following in order to bill this service: / Follow up with tasking providerurgently for review and/or to make any recommendations. / Should service a 99211 visit be billed?
Suture Removal / MA/CA/LPN/RN / YES / Document that sutures were removed.
Document the sight where sutures were located.
Document that wound has adequately healed.
Sutures would have been provided by ER or another provider.
Add a diagnosis of suture removal: V58.32 / Task to provider so they may review and sign off. / Yes.
We would bill 99211 since there is no code for suture removal and since we didn’t put in the sutures it is a separate service from any surgical or wound care. A diagnosis of suture removal and wound care, etc. should be added for billing.
Weight Checks / MA/CA LPN/RN / Yes / Patient here for weight check:
Newborn weight check.
Wt check as ordered by ______provider on ______date. Current weight is: ______. Patient asked if they had any questions regarding diet, etc. (If on a special diabetic diet for a medical problem, etc.)
If newborn weight check document:
  • Interval History
  • Weight
  • Pulse
  • Respiration
Add a diagnosis of:
  • 783.1 Weight gain (abnormal/excessive)
  • 783.21 Weight loss (cause unknown)
  • V20.2 Routine and subsequent newborn ck.
  • V21.30 Low birth weight status, unspecified
/ Provider reviews and signs off or tasks CA with directions. / Yes
Provider does not physically need to see patient but should be in the office. If ordering provider is not in office you need to task a provider who is working that day in the office.
Changed formula for an infant.
  • Changed diet or ordered a consult with a dietician, etc.

The following services are considered Point of Care Services and will not be billed with a 99211:

  • Blood Draw
  • Glucose Ck.
  • Immunizations (we will bill the vaccine and the administration only).
  • Lead Screen (we bill finger prick).
  • Prescription Refills
  • PPD/TB Skin Tests
  • FOBT (Fecal Occult Blood Testing)
  • Therapeutic Injections (B12, Depo’s, allergy, antibiotic injections) we will bill for the medication and the administration code only.

For any additional services that you need assistance with, please speak to your manager or supervisor.