nurse visit cpt code 2023

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Find-A-Code Articles, Published 2021, September 28

When is it proper to bill nurse visits using 99211.

by   Christine Woolstenhulme, QMC QCC CMCS CPC CMRS Sep 28th, 2021 - Reviewed/Updated Aug 29th

When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using  99211  and an E/M office visit reporting  99202  ‑  99215  and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit where vaccines are administered is not always understood. The answer depends on whether the provider performs a medically necessary and significant, separately identifiable E/M visit, in addition to the immunization administration.

CMS states, when a separately identifiable E/M service (which meets a higher complexity level than CPT code  99211 ) is performed, in addition to drug administration services, you should report the appropriate E/M CPT code reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.

It is incorrect to bill a  99211  when the provider provides an E/M service that meets a higher complexity level than CPT code  99211 , you must bill the higher complexity, and you cannot bill for two services in one day. 

Charging for Nurse Visits

There are times when it is appropriate to report for a nurse visit using CPT code  99211 . The  Incident-to rule  applies when reporting this code, and services provided must be documented as medically necessary services, including the clinical history, clinical exam, making a clinical decision, and physician supervision. 

• NOTE: A nurse visit is not paid if billed with a drug administration service such as chemotherapy or non-chemotherapy drug infusion code, including therapeutic or diagnostic injection codes. The reasoning is because diagnostic IV infusion or injection services typically require direct physician supervision, and using  99211 is reported by qualified healthcare professionals other than physicians.

08/29/2023 NOTE: (These CPT codes,90782, 90783, 90784, or 90788  were deleted in 2006, but still showing in CMS - Claims processing manual) When reporting CPT codes 90782, 90783, 90784, or 90788 , CPT code 99211  cannot be reported. In addition, it is improper billing to report a visit solely for an injection that meets the definition of the injection codes. 

When the only reason for the visit is for the patient to receive an injection, payment may be made only for the injection (if it is covered). An office visit using  99211 would not be warranted where the services rendered did not constitute a regular office visit and a part of the plan of care and not at the patient's request.

Unlike other E/M codes  99202 - 99205 , and 99212 - 99215 , time alone cannot be used when reporting  99211  when selecting the appropriate code level for E/M services. Effective January 1, 2021, time was removed as an available code-selection criterion. The typical time spent on this code is five minutes.  

Other visits billed with  99211

Several other visits may be reported using  99211 , and nurses are not the only staff that can report this code; medical Assistants and technicians are also included under non-physician.  

Covid-19 Testing

According to  CMS ; Physician offices can use CPT code  99211  when office clinical staff furnish assessment of symptoms and specimen collection for Covid-19 incident to the billing professionals services for both new and established patients. When the specimen collection is performed as part of another service or procedure, such as a higher-level visit furnished by the billing practitioner, that higher-level visit code should be billed. The specimen collection would not be separately payable.

Examples from CMS

The following are examples of when  CPT  99211  might be used:

• Office visit for an established patient for blood pressure check and medication monitoring and advice. History, blood pressure recording, medications, and advice are documented, and the record establishes the necessity for the patient's visit.
• Office visit for an established patient for return to work certificate and advice (if allowed to be by other than the physician). Exam and recommendation are noted, and the Return to Work Certificate is completed, copied, and placed in the record.
• Office visit for an established patient on regular immunotherapy who developed wheezing, rash, and swollen arm after the last injection. Possible dose adjustments are discussed with the physician, and an injection is given. History, exam, dosage, and follow-up instructions are recorded.
• Office visit for an established patient's periodic methotrexate injection. Monitoring Lab tests, query signs and symptoms, obtain vital signs, repeat testing, and injection advised. All this information is recorded and reviewed by the physician. (Note that in this circumstance, if  99211  is billed, the injection code is not separately billable). An office visit for an established patient with a new or concerning bruise is checked by the nurse (whether or not the patient is taking anticoagulants), and the patient is advised on how to care for the bruise and what to be concerned about, and, if on anticoagulants, continuing or changing current dosage is advised. History, exam, dosage, and instructions are recorded and reviewed by the physician.
• Office visit for an established patient with atrial fibrillation who is taking anticoagulants and has no complaints . The patient is queried by the nurse, vital signs are obtained, the patient is observed for bruises and other problems, the prothrombin time is obtained, the physician is advised of prothrombin time and medication dose, and medication is continued at present dose with follow up prothrombin time in one month recommended. History, vital signs, exam, prothrombin time, INR, dosage, physician's decision, and follow-up instructions are recorded.

References/Resources

About christine woolstenhulme, qmc qcc cmcs cpc cmrs.

Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code.  Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.

When is it Proper to Bill Nurse Visits using 99211. (2021, September 28). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/nurse-visits-and-injections-36866.html

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Who Can Report 99211?

Defining “nurse” for coding and reporting purposes, what are the documentation requirements for 99211, what is the current policy for reporting 99211, when is it appropriate to report 99211, what about commercial payer policies, clearing the confusion: billing “nurse” visits.

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American Academy of Pediatrics; Clearing the Confusion: Billing “Nurse” Visits. AAP Pediatric Coding Newsletter September 2005; 2005 (4): No Pagination Specified. 10.1542/pcco_book025_document001

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Questions continue to be raised about the appropriate billing of code 99211. Can this level of service be reported by a physician? Would it be appropriate to report a nurse visit when, for example, the nurse administers vaccines or an antibiotic, performs a strep test, obtains blood, reads a purified protein derivative (PPD), or performs a weight check?

The Current Procedural Terminology (CPT ® ) descriptor for code 99211 states, “Office or other outpatient visit for the evaluation and management [E/M] of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.” The key to reporting this service? It must be medically necessary and require a face-to-face E/M service with supporting medical record documentation.

A physician typically does not report this level of E/M. Usually when the visit re-quires a face-to-face with the pediatrician, a minimum of straightforward medical decision making with a problem-focused history or examination is performed and documented. That level of visit would be reported as a level 2 visit (99212) as per CPT guidelines. Certainly a physician can report 99211 when providing a service if that physician feels it appropriate, but most often these types of visits are handled by nurses, allowing the pediatrician time to treat other patients.

The American Nurses Association recognizes that “non-advanced practice nonphysician providers” can diagnosis and/or assess patients, provided it is within the state’s scope of practice laws and meets incident to billing requirements.

When a nurse provides the 99211 visit, it is reported under the physician’s name and tax ID number as an incident to service. The incident to requirements as defined by the Centers for Medicare and Medicaid Services (CMS) are that services must be integral to the physician’s professional service, must be commonly rendered without charge or included in the physician’s bill, must be of a type commonly furnished in a physician office, and are furnished by auxiliary personnel under the physician’s direct supervision. Physician direct supervision is defined as the physician being physically present in the office suite (not in the patient’s room) and immediately available to provide assistance. The patient must be an established patient with the physician involved in the plan of care. Most nurse services are provided under an established protocol developed by the physician for the particular service and should be fully documented. The physician supervising the care must sign the chart entry.

The documentation requirements for 99211 differ from most of the E/M services provided by physicians. There are no required key components (history, physical examination, and medical decision making, or time if more than 50% of the total face-to-face time is spent counseling or coordinating care) and the typical time published in CPT for 99211 is 5 minutes. The American Academy of Pediatrics (AAP) encourages documenting the date of service and reason for the visit, a brief history of any significant problems evaluated or managed, any examination elements (eg, vital signs, appearance of a rash), a brief assessment and/or plan along with any counseling or patient education done, and signatures of the nurse and supervising physician. Documentation should clearly support the medical necessity of the visit.

Per CMS policy, CPT code 99211 cannot be billed solely for the purpose of administering an immunization or injection, collecting a specimen for a diagnostic test, checking vital signs that would not affect the patient’s care, or writing new or renewal prescriptions if no other assessment was performed. Reporting 99211 with these services requires that the service be separate, significant, and medically necessary. The American Medical Association also defines a reportable E/M service as being significant and separate from vaccine administration.

Immunization and drug administration CPT codes (including therapeutic or diagnostic infusions, chemotherapy administration services, and therapeutic, prophylactic, or diagnostic injections) include administrative and clinical services in their Resource-Based Relative Value Scale work values and cannot be billed with a nurse visit when the sole purpose of the visit is for the administration. In other words, these administration codes include taking vital signs, obtaining history related to the vaccine or medication, preparing and administering the medication or vaccine, observation for reactions, and medical record documentation.

The AAP has published a position paper with clear guidelines on billing 99211 with immunization administration. For more information and vignettes on the use of 99211 during immunization administration, visit the Member Center of the AAP Web site, http://www.aap.org/moc . Click on “Coding & RBRVS” on the right side of the page, and then click on “AAP Position Paper on Reporting 99211 with Immunization Administration.” An example of one vignette follows.

The basic premise for billing this level of visit is dependent on one thing—was the purpose of the visit to provide an E/M service of a significant and separate complaint or problem, or was the purpose to perform a procedure? Is it medically necessary, and will the documentation support the medical necessity?

An example of reporting 99211 with vaccine administration is a 4-month-old patient returning for a second hepatitis B vaccine. The vaccine was not given at her well visit 2 weeks earlier because of a high fever at the time of the visit. The nurse documents

The patient is here for a missed hepatitis vaccine and has had no fever for 7 days, is eating again, and seems to be well per father. Past vaccines have been well tolerated. Her temperature now is 98.7°F and she appears well. The risk and potential side effects of the hepatitis vaccine were discussed after the Vaccine Information Statement was given and the parent was informed of the correct dosage of an antipyretic should fever or fussiness occur afterward. The night call system was explained and the access number given.

K. Brooks, LPN/R. Dunn, MD (signatures/date)

This encounter would be reported as follows:

Note that modifier -25 has been appended to the E/M code to reflect that a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service was provided. The use of a separate diagnosis code reported with 99211 also helps support the medical necessity of the visit.

Also note that the reported diagnosis is V67.59. This is correct reporting based on ICD-9-CM guidelines. Many payers, however, will not reimburse an E/M service with this code and will require you to report the “sick” diagnosis (in this case, fever). It is recommended that for these payers, you report the fever followed by V67.59.

Following are other examples for reporting 99211:

A child returns to the office for reading of a PPD administered at the last visit. The nurse documents

Patient here for reading of PPD administered on June 1, 2005. Results indicate 0 mm of induration. Discussed with parents signs/symptoms of disease.

Visit is reported as

An 8-year-old girl returns for weight check and blood pressure (BP) monitoring. The nurse documents

Patient here for weight and BP check. Last seen by Dr Jones 1 month ago. Weight 80 lb; BP 117/78. Doing fairly well with diet. Reviewed diet again with Sarah and Mom, stressed importance of increased exercise. To return for recheck in 1 month.

Note: No matter how much time was spent in counseling during this visit, only 99211 can be reported.

Remember that while most private payers follow CMS coding guidelines, they may establish their own policies for reporting and payment of nurse visits. It is important that every pediatric practice understand specific payer guidelines.

Most health plans will require a co-payment on any E/M service provided. If this is a requirement, you are mandated to collect this co-payment amount for 99211. Education is crucial to help parents understand the value of the service and that is it is a requirement of their health plan.

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The 2023 Hospital and Nursing Home E/M Visit Coding Changes

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Here’s What You Need to Know to Become a Cannabis Nurse

• Career Overview
• Licensure and Certification

Cannabis Nursing Community

Are you ready to earn your online nursing degree?

Have you ever considered a career in cannabis nursing ? The therapeutic cannabis industry is rapidly evolving, and patients need proper treatment and guidance from trained professionals. A cannabis nurse has specialized knowledge of the endocannabinoid system and the skills to manage the care of healthcare consumers with medical cannabis.

“One of the major benefits of being a cannabis nurse is witnessing patients, safely and medically supervised, reducing their prescribed medications and improving their quality of life,” says Texas-based cannabis nurse Eve Kandiyoti, RN.

This guide covers steps to becoming a cannabis nurse, work settings, credentialing, and the cannabis nursing community.

Popular Online RN-to-BSN Programs

Learn about start dates, transferring credits, availability of financial aid, and more by contacting the universities below.

What Is a Cannabis Nurse?

A cannabis nurse’s scope of practice is defined by the American Cannabis Nurses Association (ACNA) categorized by 17 standards of care.

Cannabis nursing requires a specialized knowledge of the beneficial components of the Cannabis sativa plant. A cannabis nurse has a comprehensive understanding of how to manage and educate patients on medical cannabis to treat various health conditions, including but not limited to:

• Amyotrophic lateral sclerosis (ALS)
• Chronic pain
• Crohn’s disease
• Epilepsy and seizures
• Multiple sclerosis and muscle spasms
• Severe nausea or vomiting resulting from cancer treatment

The endocannabinoid system (ECS) is a network in the body composed of three core components: endocannabinoids, enzymes, and cannabinoid receptors. This biological system helps regulate critical bodily functions such as pain, immune and inflammatory responses, temperature control, learning, and memory.

The National Council of State Boards of Nursing (NCSBN) identifies six principles of essential knowledge for cannabis nurses:

• A working knowledge of current legislation relating to cannabis
• A working knowledge of the jurisdiction’s Medical Marijuana Program
• An understanding of the ECS, cannabinoid receptors, cannabinoids, and their interactions
• An understanding of cannabis pharmacology and research
• Identifying the safety considerations for patient use of cannabis
• Approaching the patient without judgment

Several entities around the country offer specialized training for cannabis nursing , including associations like the ACNA and large public universities.

Working as a Cannabis Nurse

A cannabis nurse can work in direct patient care, research, or offer clinical expertise in collaboration with product manufacturing companies.

There are a variety of healthcare settings for cannabis nurses, including:

Dispensaries

• Helping patients with unwanted or unintended consequences of cannabis products, including side effects or concerns about habit formation
• Helping patients find the right cannabis strain
• Providing education on how to take the medication and dosing

Consulting Practices

• Educating patients on cannabis products
• Promoting safe cannabis use
• Advising on the therapeutic effects of cannabis
• Collaborating with product manufacturers in product development

Hospitals or Clinics

• Informing patients on cannabis and its medical use
• Providing support
• Advocating for patients taking medical cannabis
• Recruiting patients for clinical trials and measuring outcomes

Cannabis Nurse Credentials

Although the American Nurses Association (ANA) announced cannabis nursing as a specialty, there is not an official cannabis nurse specialty or national certification yet.

To date, the process for cannabis nurse certification includes licensure and a certificate.

The National Council of State Boards of Nursing issues an exam to evaluate nursing competency for state licensure. Cannabis nurses then earn a certificate from a cannabis nurse training program .

“Courses that offer continuing education credit, like the Cannabis Nurses Network , are excellent ways to receive a ‘certificate’ in cannabis nursing,” says Kandiyoti.

• All would-be nurses must pass the NCLEX to practice
• Nurses need only to pass the NCLEX once
• Other than passing the NCLEX, there is no other licensure requirement to become a cannabis nurse.

Certificate

• Nurses can get a certificate that shows completion of cannabis education courses.
• Earning a certificate demonstrates professionalism, continued education, and industry standards.
• The ACNA is working towards certification for cannabis nursing.

Two cannabis nursing communities are particularly well-known as hubs of the cannabis nursing community.

“The Cannabis Nurses Network and ACNA are great ways to connect with local and national cannabis nurses,” says Kandiyoti.

The benefits of joining these associations include free CEUs and webinars, networking, and a monthly newsletter. Other benefits include discounts on conferences, educational programs, and the most up-to-date literature on ECS.

Becoming a member of a professional nursing association promotes community and offers networking opportunities. You can also stay up to date on the rapidly changing laws and evidence-based practices with medical cannabis.

As of April 2023, 38 states, three U.S. territories, and Washington, D.C. , legalized medical cannabis. This surging industry offers various health benefits, including alleviating chronic pain, reducing anxiety, and improving multiple sclerosis symptoms. Cannabis nurses are in demand to educate and care for the estimated 5.4 million Americans enrolled in medical cannabis programs.

As long as you follow the scope of practice and state guidelines for cannabis nursing, you should feel comfortable providing safe and holistic nursing care to patients using medical cannabis.

Frequently Asked Questions for Cannabis Nursing

What is cannabis nursing.

Cannabis nursing is a nursing practice dedicated to caring for and educating patients on the therapeutic use of cannabis. A cannabis nurse incorporates nursing skills and cannabinoid science into patient care.

How long does it take to become a cannabis nurse?

The length of time depends on your nursing education pathway, professional experience, and knowledge competencies. Enrolling in an online course, like Advanced Cannabis Science and Therapeutics, provided by Radicle Health, can help streamline the process. Program and certificate requirements vary by state and educational institution.

Where do cannabis nurses work?

Cannabis nurses can function as consultants or work directly in dispensaries, clinics, or hospitals. Other options include working for a product manufacturing company or in a research setting.

Is cannabis a formally recognized specialty practice area?

The ANA announced they formally recognize cannabis nursing as a specialty nursing practice. However, to date, there is not an official cannabis nurse specialty or national certification yet. The ACNA is working to change that in the future.

Meet Our Contributor

Eve Kandiyoti, RN, MSN

Eve Kandiyoti is a registered nurse with over 16 years of experience and is the founder of MC Wellness Group . She is a doctoral candidate and holds a master of nursing education. Kandiyoti began her cannabis nursing journey in 2014. She has completed several medical cannabis certificates, including the University of Colorado Skaggs School of Pharmacy’s Medical Cannabis Education for Health Care Providers program. Her philosophy in her nursing practice is to empower others to be their best health advocates.

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5 Things to Know About Cannabis Nursing

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5 Steps to Become a Certified Medical Marijuana Provider in New York

Learn how to become a certified medical marijuana provider in New York by following these five easy steps.

Are You Ready to Earn Your Online Nursing Degree?

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.

Six UTA faculty receive prestigious CAREER grants

Wednesday, Jun 05, 2024 • Katherine Egan Bennett : contact

Six faculty members from The University of Texas at Arlington received more than $3.23 million in awards as part of the National Science Foundation’s (NSF) Faculty Early Career Development Program . Called CAREER, these awards are considered the NSF’s most prestigious for early-career faculty and are given to those who have the potential to serve as academic role models in research and education.

Between 2017 and 2022, UTA received nine CAREER awards; in 2023, it received six. Vice President of research and innovation Kate C. Miller called this “a true testament to the world-class research teams we’re assembling here in Arlington.”

“CAREER award winners are often considered the best and brightest in academic research,” Miller said. “It is a tribute to the outstanding caliber of our faculty and their research that the NSF funded so many UTA research projects in 2023.”

The projects and researchers supported by these grants are:

• Engin Arslan, assistant professor of computer science and engineering, for his research project “Efficient and Reliable Data Transfer Services for Next Generation Research Networks,” which focuses on improving the performance and robustness of large data transfers between research institutions.
• Remi Chou, assistant professor of computer science and engineering, for his research project “Towards Privacy-Preserving Wireless Communication: Fundamental Limits and Coding Schemes,” which aims to improve privacy-preserving protocols that will thwart cyberattacks and data breaches.
• Shirin Nilizadeh, assistant professor of computer science and engineering, for her research project “Advancing Adversarial Robustness of Natural Language Generation Systems.” She is exploring the robustness of natural language generation systems against evolving security and privacy threats. Nilizadeh’s research aims to improve the security, privacy and safety of these increasingly popular systems.
• Narges “Nora” Shayesteh Moghaddam, assistant professor of mechanical and aerospace engineering, for her project “In-situ Hybrid Layerwise Rolling and Sealing in Laser Powder-Bed Fusion Manufacturing of Tungsten: Fundamental Processing Mechanisms and Transition Temperature Controls.” She is studying tungsten refractory materials, which are known for their resistance to extreme conditions due to their high melting point and density, making them ideal for harsh environments like space exploration or defense applications. Her research will investigate hybrid manufacturing processes aimed at enhancing tungsten's durability, potentially leading to significant breakthroughs in materials engineering for industries that require materials capable of withstanding extreme conditions.
• Allison Sullivan, assistant professor of computer science and engineering, for her research project “Live Programming for Finite Model Finders,” which aims to help developers be more productive by allowing them to see how software is performing and identify where anomalies occur, so they don’t have to search through code to find a problem.
• Shuo Linda Wang, assistant professor of mechanical and aerospace engineering, for her research project “A Multilayer Dynamic Network Control for Agile, Optimized and Sustainable Supply Chains.” Her project hopes to optimize supply chain management to allow for flexibility from forces outside the supply chain, such as policy changes that can cause major disruptions.

To be eligible to receive CAREER program grants, early-career faculty (those at the assistant professor or equivalent rank) must be deemed by their departments as having the potential to lead advances in the mission of their department or organization. Activities pursued by CAREER grantees should build a firm foundation for a lifetime of leadership integrating education and research.

“I’m extremely proud of these emerging researchers and the potential societal impact of their research,” Miller said. “It says a great deal about the growth in quality and quantity of research conducted at UTA that the National Science Foundation chose to fund so many of our talented professors.”

If you're forgetting to bill 99211 for nursing visits, or using 99201 when you should be using 99202, this quick coding lesson may improve your practice's bottom line .

JAMES M. GIOVINO, MD

Fam Pract Manag. 2000;7(7):39-42

Level-one” office visits may be the simplest of patient encounters, but when it comes to coding and documentation, they are widely misunderstood. More often than not, we tend to forget to bill 99211 for nursing visits and we undercode physician visits. One of the key problems, of course, is that the rules for coding and documentation are clear as mud, while the threat of audit is clear as day. The revised revised documentation guidelines, which are at least a year away from being implemented, may help the situation. But until then, family physicians can do better by reacquainting themselves with the most effective use of level-one evaluation and management (E/M) office visit codes.

According to the CPT manual, a 99211 is an office or other outpatient visit “that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.” Unlike the rest of the office visit codes, 99211 does not have any documentation requirements for the history, physical exam or complexity of medical decision making. The nature of the presenting problem need be only “minimal,” such as monthly B-12 injections, suture removal, dressing changes, allergy injections with observation by a nurse, and peak flow meter instruction. (For more examples, see Appendix D of the CPT manual.)

KEY POINTS:

Physicians generally should not use a 99211 code for their own services, but it may be appropriate for office services performed by a nurse.

To support the 99211 code for a nursing visit, a practice must have sufficient documentation.

If physicians use code 99201 regularly, they are likely undervaluing or under-documenting their services.

None of these visits requires the presence of a physician in the exam room (although the physician should be on the premises). In fact, as a rule of thumb, a physician should not code a 99211. What these visits do require is supporting documentation, so if you plan to charge for nurses' visits, you need to train your nurses to provide very basic medical documentation. I have found the most successful method for achieving adequate and consistent documentation from nurses is to make simple, check-box-driven forms, which guide nurses' decision making, protect you from litigation and give you the clinical data you would want yourself. (For examples of flow sheets that can assist nurses in documentation, see " Documenation help .")

Documentation help

Nurse charting for 99211 visits can be minimized and made more efficient by moving it almost entirely to flow sheets, such as the two available for download below. Longer notes, such as involved phone messages, can be documented in the progress note section of the chart to avoid filling up the flow sheet with narrative information. Nursing data need not be repeated in the progress note.

In the flow sheet for depo-progesterone injections (

), the idea is, first, to collect the data needed to protect the patient from iatrogenic injury; second, to drive effective billing; and third, to minimize the effort needed for adequate documentation.

The vital signs flow sheet (

) not only improves nurses' documentation but improves physician efficiency as well by allowing for rapid review of vital signs, past office visits, routine health care and medications. To inform the physician of a chief complaint, the nurse can simply attach a sticky note to the front of the chart. Scan the sample vital signs flow sheet and see if you can get a feel for this patient without reading the progress notes.

Note that, in our practice, we highlight no-show appointments and narcotic/benzodiazepine prescriptions in green and yellow, respectively. We have found that these features alone make the form worthwhile.

If you are not sure it is worth the effort to bill for a 99211, consider that a nursing visit for a depo-progesterone shot can generate a charge of approximately $150 (nursing visit 99211=$30, Depo-Provera 150 mg J1055=$90, urine pregnancy test 81025=$38), which even after insurer discounts is a significant amount. In my office, before we standardized nursing documentation and billing, we failed to capture approximately $4,000 per year for various portions of the nursing visit for depo-progesterone shots alone. The cost to standardize nursing documentation is minimal: a few copies of a form per year. The nurses spend no more time charting and are less confused about what they should be doing.

One word of caution about 99211: You can't bill for the administration of an injectable medication (90782) or for the administration of an immunization (90471, 90472) and a nursing visit at the same time. You can either bill for the 99211 plus the medications or bill for the injection plus the medications. When the nurse must make an evaluation of the patient (e.g., when giving a depo-progesterone shot, the nurse must consider, “might the patient be pregnant?”), then our practice uses the 99211. If the nurse must only give an injection, we use the injection codes.

In general, of the “new patient” codes, 99201 should be used only slightly less frequently than 99205. The goal is not to game the system and upcode, but if you find yourself using 99201 regularly, consider auditing your own billing and documentation practices. You will most likely find that you are either undervaluing your services or underdocumenting.

The 99201 code has more specific requirements than 99211 when it comes to elements of the history, physical and medical decision making. (See the table below, for the minimum required elements .) In addition, 99201 is not to be used for nursing visits, as the physician needs to see the patient and establish a care plan before nurses' visits can be billed.

Examples of typical 99201-type office visits from the CPT manual include an out-of-town patient needing refills on an NSAID, a topical preparation or an antihistamine for allergies. For documentation, remember to record a chief complaint, one element from the HPI and one physical exam bullet, and specify a diagnosis and plan.

99201 quick reference

Unlike code 99211, which has no specific documentation requirements, code 99201 for the evaluation and management of a new patient requires a problem-focused history, a problem-focused examination and straightforward decision making, as outlined in the table at right.

Bottom line

When it comes to level-one office visits, three general rules should keep you on track:

Don't forget to bill for the nurse's time and expertise by using the 99211 code.

Use check-box forms to drive adequate documentation, to achieve consistency between nurses and to capture all appropriate fees.

Consider the use of a 99211 or 99201 for a physician visit as a red flag indicating potential undercoding.

If you are tempted to downcode for your poorer patients, remember that you will be committing fraud by billing one group of patients differently from another. Medicare gets very upset about this. The best way to help your patients who are less able to pay is to use the correct billing codes and documentation but use financial hardship forms to adjust their bills or set up reasonable payment schedules.

Proper coding and documentation is crucial to the success of any medical practice. If you spend a little time making sure you and your staff understand level-one visits, you may find that it enhances your practice's bottom line and protects you from legal trouble.

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Want to make six figures? These are 8 high-paying software engineering jobs

If you’re looking to make a move into software engineering , there’s good news: Demand for these roles is on the rise. According to the U.S. Bureau of Labor Statistics, the number of jobs available in the field is expected to grow by 25% by 2032. 

To enter the software engineering industry or advance your career with a new job title, you’ll need to know the most common options, their pay rates and day-to-day responsibilities, and the skills needed to handle the workload. 

If you’re looking to enter the tech workforce and don’t know where to start, Fortune ranked the best software engineering bootcamps .  

8 jobs for software engineers

Below are the top eight jobs for software engineers, ranging from data-heavy roles to creative-centric ones. Note : This list is alphabetical, and the salaries were sourced from Glassdoor. Pay may vary from company to company.  

Data scientist  

Average yearly salary : $157,000

For the past few years, data science has topped CompTIA’s State of the Tech Workforce report as the fastest-growing tech occupation, and for good reason. Data scientists are crucial in almost every industry, including healthcare, urban planning, and social media. 

By utilizing models and algorithms to explore, analyze, and optimize data, their work involves solving problems and communicating results to stakeholders. There are two main routes to becoming a data scientist: obtaining either an undergraduate or graduate degree or attending bootcamps . 

Skills : Proficiency in programming languages like Python, R, and SQL, as well as skills in machine learning, data visualization, and data mining, are essential. Additionally, soft skills such as problem-solving, critical thinking, and effective communication are important for success in this role, especially when working collaboratively in a team.

If you’re interested in learning Python, either for this career path or maybe one of the ones listed below, we analyzed the 11 free and paid courses for beginners.

Cloud computing engineer

Average yearly salary : $147,000

According to Acumen Research and Consulting, the global cloud computing market accounted for $495.3 billion in 2022 and is estimated to grow 17.8% by 2032. Also simply called “cloud engineers,” these highly skilled people are responsible for designing, developing, refining, and maintaining cloud-based infrastructure, applications, and storage services. 

Cloud engineers typically have a background in computer science, information technology or a degree in a related field. Proficiency in Google Cloud, Azure, and Amazon Web Services (AWS) is also a must. 

If you don’t understand the cloud, try to think of services like Google Drive, Dropbox, Microsoft Office 365, Zoom, and even streaming apps like Spotify and Netflix. The cloud isn’t a physical thing but rather a network of remote storage servers that can be accessed on any device with an internet connection. 

Skills : Cloud engineers’ technical skills revolve around understanding system architecture and automation while balancing soft skills like problem-solving and communication. 

Cybersecurity engineer

Average yearly salary : $162,000

According to tech staffing agency Mondo, cybersecurity engineers are among the highest-paid professionals in the cyber field. They play a crucial role in implementing and testing new security features, responding to data breaches, and overall playing digital defense against threats. Typically, people in these roles hold either a bachelor’s or master’s degree in cybersecurity or alternatively earn certifications like the CompTIA Security+ or the GIAC Security Essentials certification.

Skills : Python, JavaScript , SQL, PowerShell, and Bash are among the most common programming languages for cybersecurity professionals. Some soft skills include adaptability, attention to detail, and an eye for computer forensics. 

Machine learning engineer

Average yearly salary : $164,000

As artificial intelligence and machine learning continue to advance, there is an increasing need for people skilled in developing, training, implementing, and updating automation and AI systems. Machine learning engineers dedicate their time to gathering and preparing data, constructing and refining models, and collaborating across teams to get these models into production. Think: The team behind OpenAI’s GPT-4o. 

Skills : This role involves coding languages like Python—the language of choice in machine learning—or Java and C++ while using data libraries like TensorFlow, Microsoft Azure, and PyTorch.  

DevOps engineer

Average yearly salary : $140,000

A DevOps engineer is a professional who excels in both software development and operations, serving as the bridge between development and IT teams. They establish an effective workflow, enabling developers to introduce new features and build applications while ensuring that operations teams maintain the stability of released applications.

This job is typically reserved for people with university-level education, postgraduate degrees, or industry certifications. Microsoft offers a free 9-module, self-paced DevOps engineer training course with an expert-level certification. 

Skills : Experience with programming languages, data management, library updates, and security systems is essential for this role. Familiarity with Continuous Integration/Continuous Delivery (CI/CD) is also required. Strong analytical, problem-solving, and teamwork skills are a must.

Full-stack developer

Average yearly salary : $120,000

Becoming a full-stack developer involves tackling both the front-end and back-end of web development and taking responsibility for designing, building, and maintaining an application or website. This includes using tools like Figma for UX/UI design and APIs and databases for processing and storing site data. 

To land a job in this field, whether as a freelancer or full-time employee, it’s essential to build a strong portfolio showcasing various projects on the client and server side. 

If you’re looking to hop into this career path but don’t want to do it alone or for a high price tag, we rounded up five web development bootcamps .

Skills : There are several regularly used programming languages in full-stack web development: HTML, CSS, and JavaScript for the front end and C++, Python, and Ruby for the back end. Similar to cloud engineers, full-stack developers should also have a good understanding of streaming technologies for internet-based tasks. Lastly, continuous learning and a growth mindset are crucial aspects of this role, as they enable developers to understand and fix coding issues when they arise.

Game developer  

Average yearly salary : $116,000

The gaming industry is projected to reach $312 billion by 2027, making it one of the hottest industries on the planet, but for video games to exist, there must also be game developers. These professionals merge sleek user interfaces with game logic, artificial intelligence, and creative visual design. They collaborate closely with game designers to translate concepts into code. These developers iterate and refine gameplay for production on a day-to-day basis.

Full Sail University offers video game development programs, but learning the basics of programming independently or through regular computer science classes is entirely possible with dedication and a study routine. 

Skills : Game developers should know how to code for console, computer, or mobile and also understand new trends like augmented reality (AR), virtual reality (VR), and extended reality (ER). Common programming languages in the video game industry are Java, Python, HTML5, and JavaScript. 

Mobile app developer  

Average yearly salary : $117,000

There are more than 1 billion active iPhones and more than 3 billion active Android devices. Mobile app developers are responsible for products like Safari, Google Chrome, Instagram, TikTok, your cell phone’s calculator, and everything in between. More specifically, they conceptualize, program, debug, maintain, and update platforms ranging from video games to utility. 

Skills : Apps either run on Apple’s proprietary iOS or the Android open-source operating system. The former is typically coded in Swift, and the latter is typically coded in Java. 

Why choose a job in software engineering?

Software engineering is a rewarding career choice for several reasons. Just think about it—software is everywhere, from smartphones and smart home appliances to computers, wearables, chatbots, satellites, and content management systems. It’s omnipresent, and someone has to design, test, and develop it. 

Other reasons to dive into a software engineering job include:

• It’s a fast-paced and challenging industry.
• Your expertise will be valued across the globe, as programming serves as a universal language.
• Due to the substantial demand and specializations needed for this role, it is one of the most lucrative professions . 

Whatever your reason for selecting a software engineering job, it’s important to prioritize roles that resonate with your career goals and passions. Whether you have transferable skills, a strong affinity for numbers, a natural inclination for coding, or a passion for video games, finding a role that aligns with your strengths is important. 

Remember that the positions we mentioned are typically not entry-level, as they demand years of experience in programming and project management. If you’re aiming for such roles, consider gaining relevant experience through internships or by filling your portfolio with projects related to the field.

Frequently asked questions

What do you need to become a software engineer.

To become a software engineer, it’s important to have strong technical skills such as programming proficiency and a deep understanding of computer systems. Additionally, a passion for problem-solving, attention to detail, and patience are essential traits for excelling in this field. While a formal degree is not always necessary for entry-level positions, showcasing your skills through a portfolio filled with relevant projects can be an effective way to demonstrate your qualifications to potential employers or clients.

What is the highest paid software engineer job?

From our research, we found that machine learning engineers are among the top-paid professions in the software engineering field, with an average yearly salary of $164,000. 

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