sparkyboop
Guest
How do I get paid for the 99364 Anticoagulant Management? Is there a modifier that needs to be used?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki 99364 Anticoagulant Management
- Thread starter sparkyboop
- Start date
johnmeyer
Guru
I really don't see anything in the guidelines that says you have to use a modifer with that code. Has your provider documented at least 90 continous outpatient days of thearpy? That's the only reason I can think of at this time that you're getting the denial.
mitchellde
True Blue
Medicare and many other payers stated early on that 99363 or 99364 would not be paid on the same day as an office visit even with a 25 modifier. So it needs to be a stand alone service, needs to be performed by the physician/NP/PA, and must be 90 days from the previous 99363 or 99364 and you must have a minimum of 3 PT/INR results, If you have all of this and are still not being paid what is the denial reading? Also the dx code we have been using is V58.83 and V58.61 and we have had not problems being reimbursed. Timing can be a problem though because 90 days is 90 days and cannot be anything short of.