Failure to bill for nurse counseling: an opportunity missed.

Auditing the billing process in your office may be time-consuming, but it can improve your bottom line. One potential missed billing opportunity, for example, could be the time that your nurse spends counseling patients. In a busy practice, your nurse may be spending a significant amount of time with patients during and after a test (example in figure shows time spent on counseling in an allergy test patient encounter), explaining all the changes that they could make to improve their health. An audit might disclose that while the charges for the testing were being captured and submitted, the counseling time was not.

The description of CPT code 99211 states, "office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician." In most of these cases, the presenting problem is not serious, and only about 5 minutes is typically spent performing or supervising these services. Nevertheless, don't overlook these charges (figure). The potentially lost income could add up to a substantial amount.

Steven F. Isenberg, MD

Dr. Isenberg is an otolaryngologist in private practice in Indianapolis; [e-mail]

Figure. Do not overlook reimbursements for nonphysician
counseling (CPT code 99211). (The fees and other amounts
shown here are fictitious and used for illustration
purposes only.)

           CPT     Billed   Allowed   Insurance
Carrier    code    amount   amount    payment

National   99211   $42.00   $20.50    $20.50
Carrier    95024   275.00   165.00    165.00
           95004   165.00    62.50     62.50