Cardiology Coding Alert

Reader Question:

Coumadin Controversy

Question: How should we code for management of coumadin therapy?

Anonymous Subscriber

Answer: Some coders maintain practices can bill 99211 (office or other outpatient visit, established patient) as well as 36415 (routine venipuncture). Others say only the procedure code can be billed.

According to the American College of Cardiology (ACC), the answer depends on what services are actually rendered at the time of the visit.

For example, if the patient comes to the office and the nurse performs minimal level of evaluation and management services, such as taking a history and physical and adjusting the dosage, then you can code this visit by reporting the lowest level of evaluation and management codes: 99211.

Medicare confirms the ACC position. The services must be documented in the patients chart and countersigned by the physician, HCFA notes. However, if the nurse only performs the venipuncture, and does not provide any E/M services, then you can only report the venipuncture code, say both ACC and HCFA. (Telephone calls to the patient are also not billable, adds ACC.)

Before you bill 99211, check the documentation carefully to see if minimal E/M services were indeed provided. Otherwise, you run the risk of a post-payment audit. Medicare auditors are watching overbilling of 99211 very carefully, ACC notes.