99211 CPT code description, modifiers and guidelines

99211 CPT code description, modifiers and guidelines

An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.

Lets uncover the mystery of CPT code 99211 and why it’s super important in healthcare. We’ll use simple words and sentences to make it easy to understand. Get started!

Description of CPT code 99211

CPT Standard Edition 2011 describes this code as:

An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.

In other words, it is used for evaluating and managing a patient, typically involving a brief visit with a healthcare professional.

It is used for low-level, minimal medical encounters that take up little time or require making complicated medical decisions. It is frequently employed by medical assistants and other non-physician healthcare professionals for routine administrative or clinical tasks.

When is it appropriate to use CPT code 99211?

This code is often applied to patients who are “established,” meaning they have a history of receiving care from the facility.

  • Services billed with 99211

It is used for a quick physical evaluation and management by a healthcare expert. 99211 is usually used to treat minor treatments like blood pressure checks, flu shots, or mild illnesses or injuries.

For instance, A patient comes to the office to check their blood pressure. This code should be recorded if the visit was set up because the doctor asked for it. There could be medical justifications for the visit if the patient asked for it, which should be used in that case.

Services that should not be billed using 99211CPT

This code is for the most basic healthcare interactions with regular patients. As a result, it shouldn’t be used to charge for the following complicated services or circumstances.

  • When the results of a blood pressure check do not help with treating a sickness or illness.
  • Whether or not a separate injection or infusion code is entered on the claim, giving normal drugs by a doctor or other staff members.
  • Diagnostic or therapeutic procedures (particularly when they are not covered/reimbursed or packaged with another service) Whether the claim procedure code is submitted separately.
  • Services that require significant medical decision-making, evaluation, and management or a higher level of complexity.

Also read: 58662 Cpt code description, modifiers and reimbursements

Documentation requirements for billing CPT 99211 code

To bill for CPT code 99211, the documentation must include the following:

  • Patient’s presenting problem
  • A brief history of the patient
  • Examination findings that support the medical necessity for the visit.
  • Time Spent
  • A note of any medications prescribed or administered during the visit.
  • Compliance with Guidelines

Can CPT code 99211 be used for telehealth visits?

Yes, it can be used for telehealth visits if the criteria for the code are met and if the visit is conducted via a telehealth platform.

However, when billing for CPT code 99211 in a telehealth context, proper documentation and adherence to telehealth laws are crucial.

The reimbursement rate for CPT code 99211

The payer and geography impact how much is reimbursed for CPT code 99211. It is frequently used for standard office visits, such as blood pressure checks or basic wound treatment, and is ordinarily the lowest level of evaluation and management (E/M) code. It receives an average Medicare reimbursement of about $23 nationwide per patient.

Leave a Reply

Your email address will not be published. Required fields are marked *

You May Also Like
What is CPT code 96372

What is 96372 CPT code description, guidelines, reimbursement?

CPT code 96372 is described as: Therapeutic, prophylactic, and diagnostic substances by subcutaneous or intramuscular injection or infusion; single or multiple (e.g., influenza vaccine, antibiotic, pain medication, allergy medication, hormone replacement therapy, contraceptive).
What is 90791 CPT code description

What is 90791 CPT code description

CPT 90791 code is reserved for basic, minimal, and uncomplicated healthcare encounters with established patients. It should not be used for complex, new patient visits