Medicare Compliance & Reimbursement

Coumadin clinics will welcome new anticoagulant codes. You'll have two new codes to report anticoagulant management for patients taking warfarin starting in January.

The codes include physician review and interpretation of the International Normalized Ratio (INR) testing, plus patient instructions, dosage adjustment and ordering of additional tests. Code 99363 covers the first 90 days, including at least eight INR measurements, and 99364 covers each additional 90 days, including at least three INR measurements.

These two new codes "will be a welcome addition for practices with protime or coumadin clinics," says Sheldrian Leflore, revenue management educator with The Coding Group, a division of IRM in Carlsbad, CA. In the past, you haven't had a code to describe anticoagulant management, and some coders have caused controversy by using 99211 for this service, she says.

More changes: The descriptors for inpatient consultation codes 99251-99253 delete the word "initial" to account for the fact that last year's CPT update deleted the follow-up inpatient consultation codes.

CPT 2007 adds 199 new codes and deletes 105 old codes. These include some HCPCS and Category II and III codes. It also makes corrections to the descriptors of dozens of other codes.

As with last year, there's no grace period for the new codes. You have until January 1 to get up to speed on them, or you could face some shocking reimbursement problems.

You'll also welcome two new codes for ventilation assist and management in the hospital or observation setting, for the first day (94002) and each additional day (94003). Also, January will bring new codes for ventilation assist and management in the nursing facility (94004) and home ventilator management care plan oversight of at least 30 minutes (94005).

CPT 2007 also includes three new codes for laparoscopic supracervical hysterectomy (58541-58543) and one code for laparoscopic radical hysterectomy with bilateral total pelvic lymphadenectomy and biopsy (58548).

And you'll finally have codes for administering the antibody to the West Nile virus (86788-86789).