Wiki 85610 with E/M?

[Bernadette10]

Does this support 99213 with 85610-QW? I'm thinking yes since the med was adjusted? She was seen by the physician.

CC / HPI:
Here for her INR check. She states that she has been feeling well with exception of experiencing some grief after having to euthanize her dog that she has had more than 10 years. She is currently taking Coumadin 5 mg daily.

PE:
AAOx3 female in no acute distress. Chest: AP RRR without murmur. Lungs CTA. No peripheral edema. Psych: Unremarkable.

Dx:
Z79.01-V58.61 Long term (current) use of anticoagulants


INR 1.8 Normal (min): 2.0 Normal (max): 3.4
PT 21.7 Normal (min): 22.7 Normal (max): 35.4
QC Pass pass

Plan
A return visit is indicated in 1 week and as needed.
Z79.01-V58.61 Long term (current) use of anticoagulants
INR 1.8 today
-will change the warfarin to warfarin 5 mg daily with 7.5 mg Tuesday and Saturday
-recheck one week

 

[TThivierge]

Bernadette
What is the illness reason patient is getting Z79.01? There can be reasons such as Vit K, Pulmonary Embolism, DVT, Cardiac stroke Liver Ds or BRBR syndrome, Etc.. The provider needs to list this disease patient is suffering with then add dx Z79.01. The CPT 85610 can be linked to dx R79.1 blood coagulation too
I hope this information helps you
Lady T

 

[Bernadette10]

Thanks, I also found this after more searching. I don't know why I didn't see it before.
Wiki - PT/INR and E/M with modifier 25 in Long term care | Medical Billing and Coding Forum - AAPC
You're correct in that the 85610 is for the test only. Labs don't have an E&M component, so any evaluation and management of the patient, including adjustment of the dosage, would be a component of an E&M code, if the documentation requirements are met (modifier 25 is not required for most payers because the E&M should not bundle to a lab charge). In a facility location though, you cannot bill physician services under 'incident to' rules as you could for a nurse visit in the office, so a dosage adjustment alone would not qualify for an E&M charge - the provider would need to see the patient and there would have to be documentation of a face-to-face encounter with the required elements in order to bill an E&M code.