coding cpt 99211 - when performing lab code 83036

Office Visits Primarily for the Purpose of HbA1c Testing

The following evaluation and management code may be billed in addition to 83036 or 83036 QW for A1c testing under certain circumstances.

99211 Office or outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.

Physician interpretation of test results is considered to be part of the evaluation and management services provided to a patient during an office visit and is not separately billable. However, if a patient sees a nurse or other non-physician health care professional for the purpose of A1c testing (for example, to monitor insulin therapy) and the nurse takes vital signs, compares the results of the A1c test to predetermined guidelines, and advises the patient accordingly, 99211 may be billed.

Patients with abnormal results or other indications not covered by established guidelines should always be referred to a physician. The level of office visit then reported would depend on the evaluation and management services provided by the physician. When a Metrika A1cNow test is provided to a patient by a physician for home testing at a later date, the test may be submitted for payment when the patient notifies the physician of the result and it is entered in the medical record. The date of service would be the date the  test is performed, not the date the test materials are provided to the patient. If the patient fails to perform the test, the physician may bill the patient for the cost of the test materials;

however, the test itself can not be billed to Medicare or the patient since it was not performed.

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