The 2011 CPT Standard Edition manual defines CPT code 99211 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.

CPT Code 99211:

CPT Code 99211 means “Office or other outpatient visits for the evaluation and management of an existing patient that might not need the presence of a practitioner”.  According to CPT, the presenting problems are usually minor, and these services are performed or supervised in an average of five minutes. Minimal problems might not necessitate the presence of a doctor or other competent healthcare provider, but they still require the professional’s supervision to be addressed. Every day, the first hospital treatment for a patient’s assessment and care requires these three crucial components:

• A thorough or deep history.
• A deep or thorough examination.
• Decision-making in medicine that is simple or low in complexity.

Depending on the needs of the patient and/or family as well as the severity of the problem counseling and/or care coordination with other organizations are offered.  Typically, the issues that need to be admitted are not very serious. Doctors usually spend half an hour with patients at their bedsides and on hospital floors or units.

Example of CPT Code 99211:

An existing patient brings up discomfort and excessive urination with the doctor. Moreover, the nurse talks with the doctor about the condition, gathers a focused history, looks over the medical file, and requests a urinalysis. So Upon receiving the results from the nurse, the doctor prescribes antibiotics. The nurse records the visit in the patient’s medical file and gives the patient the instructions. Since the E/M service in this case is separate from the lab service and appropriate for assessing the patient’s complaint, 99211 and the relevant laboratory code for the urinalysis should be reported.

How Much Time Is Allotted for an Evaluation?

When doing evaluation and management visits that take no more than five minutes, the CPT code 99211 should be billed. Typically, a registered nurse or other adjunct to the client’s psychiatrist will utilize this code. Extended visits are billed and associated with additional CPT codes. These codes are as follows:

• A management and evaluation visit (code 99212) should not exceed ten minutes.
• CPT Code 99213 is used for a 15-minute evaluation and management visit.
• CPT Code 99214 is used for a twenty-five-minute evaluation and management visit.
• CPT Code 99215 is used for a 40-minute evaluation and management visit.

The client’s symptoms or circumstances usually dictate which code is utilized and how long a visit lasts. With an extended stay, the impact of the symptoms will reduce.

Using CPT Code 99211 Appropriately:

We provide the following suggestions since it can be confusing to apply CPT code 99211 appropriately. Remember these important details about CPT Code 99211:

• The service needs to be for management and evaluation (E&M).
• The service must be for evaluation and management (E&M).
• An already-existing patient, not a new one.
• The service needs to be done on the same day as other services.
• The patient and provider must speak in person, not over the phone.

Code 99211 will only be allowed if corroborating proof shows that services meet the minimal standards for an E&M visit. For instance, 99211 would not be suitable if the patient merely gets a blood pressure check or has blood drawn. Since the member’s office visit benefit is applied to all E&M office visits, if a different Procedure code better captures the service, it should be reported rather than CPT Code 99211.

If an evaluation and management (E/M) service that meets a higher complexity level of care was performed separately and is identified as such, Medicare will pay for medically necessary office/outpatient visits that are billed on the same day as a drug administration service with modifier 25.

When It Is Unable to Bill CPT Code 99211:

This code should not be used by doctors or employees to bill for:

• regular drug administration by a doctor or staff member, regardless of whether an injection or infusion code is separately reported on the claim.
• taking a blood pressure reading when the information is not useful for treating a disease or condition.
• Taking blood for a complete blood count panel, laboratory analysis, or other diagnostic testing;
• whether or not a separate claim is filed for the venipuncture or other diagnostic study test
  Medical records faxed.
• Calling patients to update them on lab results or to arrange procedures.
• carrying out therapeutic or diagnostic treatments (particularly when the treatment is paid for in conjunction with compensation for another service, or is otherwise often not covered or reimbursed) if the procedure code is provided on the claim independently.
  test findings being entered into medical records.
•  Vaccine reporting.
•  Prescription writing (new or refill) when no additional assessment and management are required.

Who is authorized to bill for CPT Code 99211?

Medicare law restricts billing for CPT Code 99211 and any other medically essential E/M services to physicians and certain non-physician practitioners (NPPs) such as nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse midwives.

Conclusion:

To accurately report services and guarantee proper compensation, the majority of practices and physicians rely on medical coding and billing service providers due to the constantly evolving difficulties of claims administration and processing. To properly record CPT Code 99211 services, medical coding service providers must teach physicians about maintaining accurate documentation. Additionally, this will guarantee a more advantageous medical record for every clinician participating in the patient’s care.