Wiki 99211 with INR monitoring

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ded1982

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Our pharmacists provide evaluation of patient's for managing their Coumadin and there have been some recent questions as to what the appropriate code CPT code is for them to be charging. Right now they have been charging the 99211 and not the 93793 because our pharmacist feels as if they are providing more a service to the patient then what the 93793 entails. The visits are face-to-face and they are reviewing the current medications the patient is on and discussing any complaints or questions they might have. They might adjust the medication depending on what their INR was. Is it appropriate for them to bill the 99211 or should they be billing the 93793 unless they are having to adjust the medication, in which case that would allow for the 99211 to be appropriate? Anyone have any input?
 
The 93793 is a code that was created specifically for this purpose and by description includes all the activity described by your pharmacists. so I say no you cannot substitute the 99211.
 
Pharmacists cannot bill E&M services in most cases (I think NC may be an exception, and even there only for pharmacists that have a special credential). The only way you can correctly bill a 99211 for the pharmacist's services is if they are providing an 'incident to' service that meets all of the requirements (i.e. an E&M ordered by a physician as a part of their plan of care, provided by an employee of the physician and under their direct supervision, etc.). If you are billing this or any other services under the physician, it's essential that these requirements be met. In your example above, you would also need to support that the 99211 was a separately identifiable service from the 93793 that is supported by documentation - it can't be billed simply because the pharmacist 'feels as if the are providing more' to the patient.
 
Ok, and that's the direction that my thoughts were going as well. However, since 93793 is a new code as of January this year what should be have been using prior to 2018? Is the 99211 appropriate during that time?
 
As mentioned above, 99211 is only appropriate for a pharmacist if they're performing services incident to a physician, which is an unusual situation as most pharmacists are not physician employees and don't work under physician supervision. What payers would you be billing with this code, and under what provider's credentials? Since pharmacists can't be enrolled under their own credentials in Medicare or many other payers, there's really no other way to bill CPT codes for a pharmacist's services.
 
Can you provide me with the guidelines for this, please??

We are still billing a 99211 for the anticoagulant management but if I am understanding you correctly this has changed with the new 93793 code.

Thank you!
 
Torilyn said:
Can you provide me with the guidelines for this, please??

We are still billing a 99211 for the anticoagulant management but if I am understanding you correctly this has changed with the new 93793 code.

Thank you!
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Pre 2018, you would have used 99363 and 99364 instead of 99211
 
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