Advanced Search

Cardiology Coding Alert

Reader Question:

Refrain From 99211 for Protime Checks

Published on Thu Jan 01, 2004

Question: We bill 85610 for Protime and 99211 for a Protime encounter in our office. The nurse has a list of questions she asks the patient prior to the draw. Are we allowed to charge the patient the 99211? We are also beginning to draw lipid profiles and will charge the patient the 99211 visit, along with 80061 (Lipid panel). Should we charge 99211 for this service as well?
 
Indiana Subscriber
 
Answer: If the list of questions the nurse asks prior to a Protime draw is standard procedure for every patient, this would be part of a typical or routine Protime check and would not justify billing a separate E/M service, such as 99211. The same logic would apply to patients coming into the office just for lipid profile blood draws.
  
For you to bill 99211, the documentation must support that staff provided a separate E/M service in excess of that typically provided to a patient just coming in for the test. You must document medical necessity, such as noting that the patient is having difficulties with the medication. Also, for Medicare (and some other payers) you must meet incident-to guidelines, which means, among other criteria, that the physician be in the office suite.
  
But keep in mind that you can bill separately for your blood draw. Use 36415 (Collection of venous blood by venipuncture) or report G0001 (Routine venipuncture for collection of specimen[s]) for Medicare patients. Make sure that the procedure is truly a blood draw and not a finger, heel or ear stick (36416, Collection of capillary blood specimen). Many practices perform Protime tests on blood collected by finger, heel or ear sticks, as opposed to venipuncture. Medicare and a growing number of non-Medicare payers do not reimburse for collecting blood this way.

Other Articles in this issue of

Cardiology Coding Alert

View All