When the patient is seen only by clinical staff overseen by the provider, which code should be reported?

When the patient is seen only by clinical staff overseen by the provider, which code should be reported?

• A. 99211
• B. 99212
• C. 99354
• D. 99000

Answer: (A)

When the encounter is conducted by clinical staff under the supervision of the provider, the visit is billed at the lowest level of E/M service that reflects minimal physician involvement. This situation matches the office/outpatient code set that describes an established patient visit performed by a nurse or other qualified health professional with physician oversight, typically around 5 minutes of staff-performed work. That’s why the appropriate choice is the minimal level outpatient visit code. Higher-level codes require more direct involvement by the physician or another qualified clinician in history, examination, or medical decision making, which isn’t the case when only staff see the patient under supervision. Codes for prolonged service or miscellaneous services aren’t applicable here.

When the encounter is conducted by clinical staff under the supervision of the provider, the visit is billed at the lowest level of E/M service that reflects minimal physician involvement. This situation matches the office/outpatient code set that describes an established patient visit performed by a nurse or other qualified health professional with physician oversight, typically around 5 minutes of staff-performed work. That’s why the appropriate choice is the minimal level outpatient visit code.

Higher-level codes require more direct involvement by the physician or another qualified clinician in history, examination, or medical decision making, which isn’t the case when only staff see the patient under supervision. Codes for prolonged service or miscellaneous services aren’t applicable here.