Wiki 99211 and PT billing

[bquestell]

Hello,

I just found out that we may have not been coding 99211 and PT billing correctly. Does anyone have any insight into this? We have a lot of patients on warfarin/coumadin and our previous billing person told us to always code a 99211 when these patients come in to get a blood draw. Looking at the literature doesn't really clarify it. It seems like a lot of gray areas.

Thanks

Becky

 

[mitchellde]

If the patient comes in just for the blood draw then you may not use a 99211 for this activity it is a blood collection encounter and must be billed using the blood collection code. (36415, 36414) Just because vital signs may be taken does not qualify this encounter to be billed as a 99211.
However per a decision health article written Feb 11 2002, the compliance office for CMS decided the following:
If you are going to call this a "Coumadin encounter" then the following must be documented by the nursing staff (not as a flow sheet)
* the patient's entire body must be checked for bruising (clothes off!)
* the patient's diet must be discussed and the compliance to the doctor prescribe diet detailed
* the patient's meds must be listed and the daily routine described and the patient compliance
* the blood collection documented
* the past PT and today's result documented
* discussion with the physician regarding the result and patient compliance documented
* any physician ordered change in medication and discussion with patient documented.
All of this must be face to face with the patient THEN you may bill this as a 99211 and not use the blood collection code.
This is a lot to document and it takes a lot of auditing to make sure they capture all the elements each time.

 

[bquestell]

Thank you very much. It is really hard to decipher what Medicare wants. Really helpful.