You are losing $15 every time you fail to report CPT code 99211 for eligible services. That means, in a single year, you are missing $20,000 for nonphysician services you already provide.
Don’t avoid using 99211 due to your fear of denials and audits.
You can boost revenue by learning when to compliantly use this code. Stop losing money today with 3 strategies that will help you inject more nonphysician work reimbursement to your practice without added scrutiny.
Expand CPT Code 99211 Eligibility to MAs, LPNs, and Other Staff
CPT code 99211 is often called the nurse visit code. But it’s not just for nurses! Many of your practice employees can provide the service. They must be qualified to evaluate and meet the patient’s care needs in a limited capacity. That means, you can bill 99211 for a medically necessary, face-to-face established patient service performed by a healthcare professional including a:
- Medical Assistant (MA)
- Certified Nurse Assistant (CNA)
- Licensed Practicing Nurse (LPN)
- Registered Nurse (RN)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Physician (MD).
Prevent Denials, Prove Medical Necessity for CPT Code 99211
One of the big reasons CPT 99211 is denied is because clinicians don’t meet the medical necessity requirement. In order to bill code 99211 you must indicate that the service is medically necessary. This isn’t as daunting as it seems.
In determining if the visit meets the medical necessity requirement, ask yourself this question: Is the purpose of the visit to provide patient care that influences a physician’s medical decision making or needed patient education? To prove medical necessity – and overturn a denial, you’ll need to keep detailed documentation, including:
- 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.
Add $15 Revenue for Needed Check-Ups, Abnormal Results, and More
Visits billable by CPT 99211 are short, and you are probably already providing many of these services for your patients. Don’t exclude routine services from being eligible for the nurse visit code. You can use the code for routine services that are medically necessary such as the following examples:
- A scheduled follow-up visit for weight check for a patient recently placed on a new medication known to cause weight gain
- A blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure
- Discussion with patient in-person following abnormal laboratory tests
- Suture removal following placement by a different physician/physician group
- Diabetic counseling that is non repetitive
- Dressing change for an abrasion/injury
The bottom line is if you aren’t using CPT 99211 for your non-physician work, you are giving their time away. This is where nationally recognized expert coder and educator Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO. In her online training CPT Code 99211: Get $15 Per Patient on Nonphysician Work, she will tell you precisely how to accurately use code 99211, and help you get paid for more visits.
Check out our Coding and Billing Playlist on YouTube for the latest expert advice, and subscribe to our YouTube channel for step-by-step guidance!
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