CHC Billing - Coding Question 99211 rules
Our state recently told us that we can’t bill a 99211 done by an RN unless a midlevel or a Dr. is onsite. We hadn’t heard this before. Have you heard this? We commonly bill a 99211 if the client is seen by an RN and the client is already established.
Assuming (and this is dangerous) the state is following the federal “incident to” guidelines (set forth initially in 1992) they require physical presence (and Medicare has clarified this to mean “within shouting distance”) of the provider under whose name the claim will be billed, therefore on-site. It is overlooked (ignored) by scores (I daresay thousands) of practices across the country as the 99211 is for most simply the code used for a non-billable provider visit; i.e., covers any multitude of services from conversation about diagnostic outcomes, simple walk-in issues not requiring a billable clinician, brief educational sessions, etc. However, in the end, if following these federal rules, the billable provider must be on-site.