Internal Medicine Coding Alert

Published on Fri Jan 25, 2008 PDF

Question: If a qualified nonphysician practitioner (NPP) performs a finger-stick Coumadin test, can we report a low-level E/M, such as 99211, in addition to the test code?

Wyoming Subscriber

Answer: As long as your NPP did not simply perform the test, and she has clearly documented the medical necessity for an E/M visit, you may use 99211 (Office or other outpatient visit for the evaluation and management of an established

patient, that may not require the presence of a physician ...) in addition to 85610 (Prothrombin time) with modifier QW (CLIA waived test) appended. (Note: If you don't have a CLIA waiver, your office is not allowed to bill for this test.)

Practices might report 99211 in addition to 85610 because patients who come in for Coumadin monitoring can have co-existing conditions or complications that arise from time to time. These are exceptions, however, and you should consider

each case individually. Routine separate billing of E/M services for this group of patients is not encouraged -- or appropriate.

According to TrailBlazer's policy on prothrombin time, "a physician visit is not routinely necessary to draw blood for prothrombin time or other laboratory tests. Therefore, the documentation for code 99211 or any other E/M code in this

circumstance must demonstrate a need for clinical evaluation and management."

"Alternatively, for patients who have no new clinical concerns, documentation that contemporaneous laboratory values were obtained, reviewed, and used to guide current and/or future therapy documents that a separately payable E/M service

has been performed," according to TrailBlazer, the Part B carrier for Delaware, Maryland, Virginia, Texas, and Washington, D.C. For example, if the NPP takes the patient's vital signs, checks for bruises, discusses medication compliance,

gives dietary instruction, and then documents these services, you might be able to report 99211. Of course, this is assuming there is documentation indicating medical necessity for this history and physi-cal examination.