Using and Documenting CPT Code 99211 Services Correctly

CPT® code 99211 is defined by the 2011 CPT Standard Edition manual as:

"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services."

Using code 99211 to report a low-level evaluation and management (E/M) service
Code 99211 describes a face-to-face encounter with a patient consisting of elements of both evaluation (requiring documentation of a clinically relevant and necessary exchange of information) and management (providing patient care that influences, for example, medical decision making or patient education). Documentation must be legible and include the identity and credentials of the servicing provider.

Using code 99211 to bill an 'incident to' service
When Code 99211 is billed as an “incident to” service, the physician’s service may be performed by ancillary staff and billed as if the physician personally performed the service. Documentation should include the identity and credentials of the supervising physician and the staff that provided the service. Notes should indicate the degree of the physician’s involvement and document the link between the services of the two providers.

All 99211 services that don’t document or demonstrate that an E/M service was performed and necessary will be denied upon review.

Code 99211 should not be used by physician or staff to bill for:

  • Administering routine medications by physician or staff whether or not an injection or infusion code is submitted separately on the claim
  • Checking blood pressure when the information obtained does not lead to management of a condition or illness
  • Drawing blood for laboratory analysis or for a complete blood count panel, or when performing other diagnostic tests whether or not a claim for the venipuncture or other diagnostic study test is submitted separately
  • Faxing medical records
  • Making telephone calls to patients to report lab results or to reschedule patient procedures
  • Performing diagnostic or therapeutic procedures (especially when the procedure is otherwise usually not covered/not reimbursed, or payment is bundled with reimbursement for another service) whether or not the procedure code is submitted on the claim separately
  • Recording lab results in medical records
  • Reporting vaccines
  • Writing prescriptions (new or refill) when no other evaluation and management is needed or performed