While code descriptors are rarely breaking news, one dramatic change to a low-level office/outpatient (E/M) service code descriptor that comes into place on January 1, 2022, could be a pleasant change for your practice. The level one office/outpatient E/M code for known patients has been revised. CPT 99211 descriptor in 2022 reads as “office or other outpatient visits for the evaluation and management of a formed patient that may not require the presence of a doctor or other competent health care professional.” While the descriptor for 2021 was “office or other follow-up appointments for the evaluation and management of an established patient,” this may not rely on the presence of a doctor or other competent healthcare professional. In most cases, the presenting issues are minor.
The phrase ‘Usually, the presenting problem(s) are minor’ has been removed to bring CPT 99211’s descriptor more in place with the norms of the office/outpatient evaluation and management (E/M) codes. With the phrase removed, 99211’s descriptor is more in line with the other office/outpatient E/Ms: 99202 through 99215. This modification eliminates a source of ambiguity regarding what constitutes a minor issue and what does not. Despite the difference, CPT 99211 still signifies an E/M service offered by clinical staff compared to a physician or other competent healthcare professional who may report higher E/M services.
CPT 99211 Basic Guidelines
The following guidelines can assist you in determining whether a service is eligible for 99211:
- The patient must be identified. CPT 99211 cannot be used to report services offered to new patients to the health care professional.
- An E/M service is required. That implies that the patient’s history is evaluated, a local physical examination is performed, and some decision-making occurs. When a patient arrived at the office and got a routine prescription, 99211 would not be suitable.
- If another CPT code better explains the service being offered, that code should be noted instead of 99211. If a doctor directs a patient to arrive at the office to have blood taken for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) rather than 99211 because of an E/M service was not needed.
- The service must be done separately from other offerings on the same day. For example, suppose a nurse gives instructions after a minor procedure performed by a doctor or takes a patient’s condition before encountering the physician. In that case, 99211 should not be revealed for these actions because they are considered part of the E/M service already offered by the physician.
- A physician’s presence is not always needed. Although doctors can report 99211, the purpose of CPT with the code is to provide a mechanism for reporting services provided by other individuals in practice (such as a nurse or other clinical staff member). According to CPT, the staff member may interact with the doctor, but the doctor’s direct intervention is not needed.
Medicare’s necessities are slightly different: While the physician’s existence is not needed in every 99211 service involving a Medicare patient, the service must be launched as part of the continuing treatment plan. The doctor will be a continuing member. For some insurance companies, the doctor must see the patient every third visit. Furthermore, the doctor must be present in the office suite when each support is delivered.
There are no critical components needed. Unlike other E/M codes for office visits, such as 99212, which require two of three main elements (problem-focused history, problem-focused examination, and straightforward medical decision making), the paperwork of a 99211 visit has no particular essential components.
Improves Collections with CPT
CPT Reporting 99212 can help your practice earn more money. Particular payment amounts will vary depending on the payer, but the average unadjusted 2021 Medicare payment for a 99211 service was $23.03. That implies that just five 99211 confronts with Medicare patients in a week will earn the practice more than $5,000 per year. Although this may not appear to be a large sum of money, it is a simple source of income. Most practices already provide several 99211 services but do not charge for them. Physicians can report 99211, but it is designed to document services provided by others in practice, such as a nursing assistant or other staff member. Writing 99211 services can also enhance documentation in practice. Members of staff who are aware of billing guidance are more likely to pay attention to paperwork, resulting in a more helpful health record for all providers involved in the patient’s care.
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