CPT Code 99211 In Medical Billing

CPT Code 99211 In Medical Billing

Understanding when to use CPT code 99211 on your medical billing can boost your practice’s revenue and improve documentation which will result in greater returns on your reimbursements.

Qualifying for 99211 service on your medical billing is not too hard, the patient simply must be established, and an E/M service must be provided. Additionally, the service must be separate from other services performed on the same date and neither the presence of a physician nor any documentation of key components are required as part of the documentation for the medical billing.

Another use for Code 99211 is patient education, simple rechecks, medication reviews and some procedures such as blood-pressure check, a suture removal or a simple dressing change.

An interesting point is only five 99211 encounters with Medicare patients in a week will result in over $5,000 per year. Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as a nurse or other staff member. Unlike other office visit E/M codes, a 99211 office visit does not have any specific key documentation requirements other than basic services rendered for medical billing purposes.

Since services can be rendered preferably by your staff or yourself, the documentation can simply reflect who rendered the services.

Using Code 99211 properly can bring additional revenue into your practice. According to compiled 2004 records the specific payment amounts will vary by payer, but the average unadjusted 2004 payment from Medicare for a 99211 service is around $21. Do the math, this means that only five 99211 encounters with Medicare patients in a week will result in over $5,000 per year for a practice.

This may not seem like much, but it certainly adds up and you’d definitely notice if your cash flow had a sprung a leak and you were losing $5,000 per year! Look into the benefits that using CPT Code 99211 can do for your practice.

View all Articles by: Melissa Clark, CCS-P