QUESTION: Can you bill CPT code 99211 for a blood pressure check by the nurse? The patient did not see the doctor.
Anonymous, Salt Lake City, UT
ANSWER: You may bill CPT code 99211 for a blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure. CPT code 99211 does not require the presence of the physician. To confirm the visit and documentation support billing 99211, check three things:
1) if the visit is necessary. The visit’s purpose must be to provide patient care that influences a physician’s medical decision making or needed patient education. Make sure the patient knows the reason (and benefit) and co-pay for the service.
2) has the required documentation. Standing orders are not proof of medical necessity – the visit must be part of the documented plan of care with a medically necessary reason such as “Patient to return for follow-up blood pressure check in two weeks to see if new medication has lowered blood pressure.” New patients do not qualify because there is no provider plan of care. Required documentation includes:
- Reason for the “nurse visit” via a plan of care
- Patient’s diagnosis, dose, and recent labs
- Today’s presentation/health status/new education
- Credentials of the face to face staff and provider
3) meets the payer’s guidelines for code usage such as Medicare’s incident-to requirements or a private payer’s variations. These guidelines require the physician be present in the office during the service.
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