Ambulatory Coding & Payment Report
Reader Question: Simple Nursing Services
Question: What are the guidelines on how to bill for nursing services such as dressing changes, which typically do not require a physicians order or a physicians presence? If the physician was not involved in the service, can we still use 99211?
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Answer: Physicians generally do not use 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) for their own services. It is, however, appropriate to report this code for office services performed by a nurse. According to the CPT manual, 99211 usually means that the presenting problem(s) are minimal and typically, five minutes are spent performing or supervising these services.
Nursing services are included in the facility service level under APCs, with the professional component of the patients visit billed using CPT codes. Surgical dressings applied by a physician are bundled into the professional service, so they would not be coded separately anyway. Only the appropriate E/M code for the office visit should be billed in such a case, so the most accurate is 99211.
If the patient requires anesthesia for a dressing change, bill 15852 (dressing change [for other than burns] under anesthesia [other than local]) instead of lumping it into the E/M. If any evaluation and management was done, even low level by nursing staff, you could bill the 15852 plus the E/M with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended. Use both, because 15852 indicates use of a regional block, which requires more personnel and resources.
Take care not to bill a nursing visit with another procedure, such as the administration of an injectable medication (90782) or an immunization (90471, 90472). In such cases, either bill for 99211 plus the medication J codes, or bill for the injection plus the medication J codes.
- Published on 2001-09-01
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