Tips For Avoiding Improper Use Of 99211

Level 1-established patient encounter code, 99211, can be confusing. CPT defines this code as, “the evaluation and management of an established patient, that may not require the presence of a physician or other qualified healthcare professional.

Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.” As you can see, the language is not very clear-cut.

Since the rules are a little vague, many providers shy away from reporting 99211 due to the vague nature of documentation requirements. They prefer to err on the side of caution rather than pose a compliance risk to their practices.

Let’s examine when and how to report this code, and provide specific examples that will hopefully clear up the confusion surrounding it. For even more details than those covered in this post, feel free to download our free eBrief, "Clever Auditing Approaches to 99211." 

Why 99211?

First things first, educate ancillary staff regarding the proper documentation of this service. It will improve documentation in a patient’s record, as staff will have a better understanding of what’s relevant and useful, and what’s not. There are a number of benefits to this:

• Better documentation leads to better patient care.
• Increased compliance with quality measures centered on documentation.
• 99211 can be a source of increased revenue to your practice.

Tips for Avoiding Improper Use

• Only report 99211 for established patients
• Think About the Spirit of the Law
• 99211 cannot be billed without a plan of care in place. The physician must be in the physical location of the service when it’s provided

While there are no hard-and-fast rules for when to bill with 99211, using good judgment, and having a strong understanding of the billing of this particular code will go a long way towards proper documentation, billing, and reimbursement of this level of service.

For more information download our eBrief, "Clever Auditing Approaches to 99211," to learn when to use it and how to avoid improper use: