99211 Nurse Visit Reimbursement

Quest ion:

We have been providing a high volume of injections for diabetic device replacement and insulin administration We are wondering if it's appropriate to bill a 99211 code for a nurse visit when our clinic RN or LVN provides these services. Will insurance providers reimburse for these nurse visits?

Answ er:

It depends on the setting, and whether the service(s) are medically necessary, and whether a qualified healthcare practitioner ordered/referred the patient to receive this care The coding also depends on the particular device, setting, and the service

Medicare considers insulin to be a ?self-administered drug?? which is not covered under Medicare benefits in the outpatient setting (Some commercial payers follow Medicare guidelines and do not cover self-administered drugs in the outpatient setting.) Facilities should not attempt to claim reimbursement from Medicare for the cost of insulin or the administration of insulin in the outpatient setting ? the services and drug may be reported on a claim, however, the dollar value should be entered in the ?Non-Covered?field Insulin should be reported under revenue code 0637, Self-Administered Drugs

Coding will depend on the following:

- The type of clinic where the services are performed (outpatient hospital, FQHC, freestanding clinic, etc)

- Whether the patient was referred to the clinic by a qualified healthcare practitioner

- Whether/why it is the medically necessary for the service to be performed by the clinic staff, as opposed to the patient receiving assistance from a home health aid, for example

- Whether the patient is under a plan of care established by a provider who practices at the same clinic