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Office outpatient visit9/25/2023 The presence of a physician is not always required.For example, if a nurse provides instructions following a physician’s minor procedure or takes a patient’s vital signs prior to an encounter with the physician, 99211 should not be reported for these activities because they are considered part of the E/M service already being provided by the physician. The service must be separate from other services performed on the same day. ![]() For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not required. ![]() Keep in mind that if another CPT code more accurately describes the service being provided, that code should be reported instead of 99211.99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription. Generally, this means that the patient’s history is reviewed, a limited physical assessment is performed or some degree of decision-making occurs. CPT 99211 cannot be reported for services provided to patients who are new to the physician. The following guidelines can help you decide whether a service qualifies for 99211: This is why 99211 is not reportable for providing a service at a patient’s request rather than as part of an established plan of care. Services described by 99211 must be medically necessary (i.e., clinically indicated) and be part of a plan of care by a physician or other qualified healthcare professional. Even with the change, CPT 99211 still represents an E/M service provided by clinical staff as opposed to a physician or other qualified healthcare professional who may report higher levels of E/M services. This change eliminates a source of confusion as to what is a minimal problem and what is not. With the phrase removal, 99211’s descriptor is now more synched with the other office/outpatient E/Ms: 99202 through 99215. The phrase ‘Usually, the presenting problem(s) are minimal’ has been deleted to bring the descriptor for CPT 99211 more in line with the rest of the office/outpatient evaluation and management (E/M) codes. Usually, the presenting problem(s) are minimal. While the 2021 descriptor was, office or other outpatient visits for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. In 2022, CPT 99211 descriptor reads as, office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. The revision is the level one office/outpatient E/M code for established patients. All rights reserved.While code descriptors are never big news, one key change to a low-level office/outpatient (E/M) service code descriptor that came into effect on January 1, 2022, could be a welcome change for your practice. Copyright 2020 American Medical Association. CPT is a registered trademark of the American Medical Association. View archived MedAxiom webinar training sessions on E/M here. New prolonged services codes 99417 from CPT and G2212 from CMS for 15-minute increments beyond a level-5 serviceįor additional detailed information regarding new guidelines on time and MDM as well as the other changes to the E/M codes see the AMA website here and here.Selection of the code level is based on either the newly defined level of medical decision making (MDM) or total time personally spent by the reporting practitioner on the day of the visit (includes face-to-face and non-face-to-face time) ( see Table 1).History and exam no longer used to select the level of code for office and other outpatient visits.These changes only apply to the office E/M codes and include an increase in values. ![]() The Centers for Medicare and Medicaid (CMS) finalized implementation of major changes to the E/M codes implemented by the AMA CPT Editorial Panel. Changes take effect January 1, 2021.
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