Getting Paid for PT/INR Office Testing With CPT Code 99211

Many doctors understand how to code properly for their time spent with a patient, but the waters become murky when it comes to coding for the time that their nurses spend on face-to-face visits. This is largely why CPT code 99211 is often underused.

As a general rule, CPT code 99211 is a "nurse code" that is used to bill for time that your practice's nurses spend with your patients. Some physicians wonder if it is appropriate to use CPT 99211 for face-to-face time spent with patients and, if so, how it should be used.

Using Code CPT 99211

According to the Medicare guidelines, even though CPT 99211 does not require a physician to be present in the room with a patient at the time of the visit, the service must be performed face-to-face with one of the physician's staff and the physician must be immediately available during this time. The visit must also have an impact on the patient's care, such as a change in medical regimen in order to be eligible for CPT 99211 coding.

To determine whether or not a visit can be billed for using code CPT 99211, there are some questions you should ask yourself:

1. Were you, the physician, on site when the visit with the patient was conducted?

2. Was the visit pertaining to a service that was medically necessary and was there a change in medical routine as a result of this visit?

3. Was the patient physically in your office (not on the phone) and did you or your staff have face-to-face contact with the patient during the visit?

Whether or not you can bill using CPT 99211 will depend on the answers to all three of these questions. If you can answer yes to all three of above questions, then the visit you are billing for will likely meet the requirements to capture revenue using code CPT 99211.

The following scenario is an example of when CPT code 99211 could be used effectively for PT/INR testing in your office...

Let's say you have a patient who is taking Coumadin/Warfarin Sodium. This patient comes into your office for a routine PT/INR test. You are in the office at the time of this visit, so the visit meets the first requirement for CPT 99211 coding.

Your nurse performs the PT/INR test and shows you the results of the test while that patient is still in your office. You see that the PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT 99211 coding.

Your nurse then returns to the patient and informs your patient of the changes being made to their prescription dosage. The nurse then documents the patient's record while that patient is still in the office. The "face-to-face" requirement has been met, again meeting the requirements for CPT 99211 coding.

Using the scenario above, you would be able to bill for this visit using code CPT 99211. Now let's look at a scenario where you would not be able to bill using CPT code 99211.

The same patient comes into your office for a routine PT/INR test. You are in your office at the time of the visit, meeting the first requirement for CPT 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT 99211 are not being met and you will not be able to use this code for billing for this visit.

Here is another scenario where CPT 99211 would not be used...

Let's say the same patient comes into your office for the routine PT/INR test. The patient leaves your office before you review the test results and you call back later to give the patient instructions over the phone. Because the patient was not in the office at the time the results and instructions were provided, the "face-to-face" requirement is not being met and you can not bill using CPT 99211.

Remember, you must be able to answer "yes" to all three of the criteria questions if you wish to bill using CPT code 99211. If you can answer yes to all three questions, then you should, by all means, bill using the CPT 99211 billing code in order to maximize the revenue generated for your practice.

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Your Practice Task Management System - A Guide to Office Staff Productivity

Ever wake up at 2am and remember you forgot to do something important at work? What are your chances of getting back to sleep?

"Centralized task management not only affords my staff and I the ability to track things in one place, it allows complete transparency to who is getting the job done for our clients," says Jason Barnes. "You know who is sitting on tasks and who is actually completing them."

Sixty percent (60%) of voters on a recent LinkedIn Poll agree with Jason. Only 11% use memory or paper to manage their task, while the remaining 29% use email.

What are the specific benefits of a centralized task management system?

David Allen, a management consultant and the author of "Getting Things Done: The Art of Stress-Free Productivity," provides insights into attaining maximum efficiency and at the same time relaxing, to focus energies strategically and tactically without letting anything fall through the cracks. His workflow management plan has two basic components: capture all the things that need to get done into a workable, dependable system; and discipline yourself to make front-end decisions with an action plan for all inputs into that system. In short, do it (quickly), delegate it (appropriately), defer it, or drop it.

Teamwork

The most basic aspect of any task management system is task capture, or documentation. An undocumented task is not worth tracking or talking about. Unless we capture all the tasks in a single system, we will have to rely on multiple tools, hurting our efficiency and efficacy. A centralized task management system also enables transparency. If your documented task ticket is placed in a central task repository then every member of our team sees its status.

That level of transparency across the board creates peer pressure and offers an opportunity to build a framework for formal accountability. If you have to attend regular meetings with your team to review your backlogs, your entire reputation and credibility hang on the timely completion or update of every task that was assigned to you.

These two features, transparency and accountability, formalize the concepts of teamwork and of team player. In an organization that uses a centralized task tracking system, teamwork means eliminating backlogs and a best team player is the member with a smallest backlog. Additionally, when a team member fails to complete a task, the other members know precisely who and when needs help. Teamwork takes specific meaning in terms of helping a specific member accomplish a specific task at a specific time. A centralized ticketing system eliminates the fluff that is usually associated with the word "teamwork" and offers a simple way to measure the degree of teamwork.

Patient Relationship Management

"If you really want to get things done I recommend you go to IQtell" says Bryan Koslow, MBA. "The best task management system that is integrated with email, calendars, and Evernote."

There are two kinds of task management systems:

General-purpose: a system integrated with email and calendars but not directly integrated with your existing practice management solution. Specialized: a task management system integrated with a patient appointment system, EMR system, and billing system, which turns your ordinary practice management system into a patient relationship management system.

To be operational and meet customer requirements, both kinds of systems must maintain a high degree of integration. The difference between the general-purpose and the specialized task tracking systems is defined by the sort of systems integrated with your task tracking system.

Getting back to practice management systems, a task tracking system integrated with patient appointment system, EMR system, and billing system, turns your ordinary practice management system into a patient relationship management system. How? The tickets can be automatically generated upon encountering a problem and directly attached to the patient records.

With a specialized system, every patient has a set of tickets distributed across multiple team members. The backlog pertaining to any particular patient defines the relationship management risk, while the backlog associated with every team member defines that member's teamwork quality. The total of all backlogs across all patients defines the current practice risk. The task of practice management reduces to ticket prioritization and to driving the ticket backlog to zero.

Pull versus Push

If you use a patient relationship management system for your practice management, you receive tickets on your workbench that pertain to your responsibilities. You do not depend on outdated reports and statuses. So if a patient owes you a balance, an integrated ticketing system will let you know about it when that patient is in front of you and without having you looking up her balance in the system. In other words, a centralized ticketing system turns your practice management system into a Just In Time Information System. The ticketing system flips the information delivery mechanism from Pull into Push, when the system is Pushing information on you instead of making you Pull it from the system.

To use David Allen's analogy, a Patient Relationship Management system downloads all those free-floating gotta-do's clogging your brain into an effective framework of action items. In other words, it's a system that pushes action items to you, frees your mind from minutiae while allowing you to focus on the big picture and important ideas.

Medical Billing Coding Certification Is Necessary to Reduce Bogus Charges and Improve Reimbursement   Medical Billing - Front End Strategies   Bare Essentials of Medical Insurance   Medical Insurance Quotes - Things That Can Affect Your Premiums   How To Keep Up With So Many Changes in Medical Billing   Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft)