Ask an Expert: Does Blood Pressure Check Qualify for CPT Code 99211?

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Ask an Expert: Does Blood Pressure Check Qualify for CPT Code 99211?

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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.

You may have more questions about who can use CPT Code 99211, how does it help me, is it changing soon, how to avoid common mistakes and implement a #1 strategy. For real-world answers to these questions in plain English, sign up for nationally recognized coding expert, Stephanie Cecchini, CPC, CEMC, CEPFG’s online training on CPT code 99211 strategies and pointers. Register now

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Meet Your Writer

Stephanie Cecchini
CPC, CEMC, CHISP, AHIMA Approved ICD-10 Trainer

Stephanie joined Aviacode in 2012 where she continues her commitment to best serve the revenue cycle management needs of physicians and the healthcare community. She is an executive level consultant with significant healthcare business experience. An expert in clinical documentation requirements for coding and billing Medicare, Medicaid and all lines of commercial payer business, she brings more than eighteen years’ involvement in healthcare regulations including: coding and billing compliance, HIPAA privacy, security, and transactions, and HITECH meaningful use compliance. Previously, Stephanie served as SVP at the American Society of Health Informatics Managers, working to fill the needs of physicians adopting Health IT and at its sister organization, AAPC as VP, Product Management. In prior roles she served as Chief Audit Officer for Parses, assuring physician audit accuracy. As a public speaker and published writer, she is a nationally respected advocate of fair and proper payment for medical services. Stephanie lives in Salt Lake City, Utah with her husband Jim and their three children.

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