Wiki Anticoagulant Management

[OliviaPrice]

I am needing more specific information on CPT codes 99363 & 99364. Can ancillary staff bill for these codes or are they specific to a physician or NPP? If a physician bills for these codes can we bill a 99211 for any visits to the office for coumadin adjustments during the following 90 days?

We run an anticoag clinic where our RN's do a full assesment of the patient an INR and make any medication adjustments recommended by the doctor. For this visit we are currently billing a 99211 & 85610.

 

[deeva456]

You are using 85610 & 99211 correctly. Medicare and most payers will not pay 99363 & 93364 in an office setting. I dont know what other providers can use these codes.

Dolores

 

[mnk8383]

99363? bundled with HH Plan of care?

My doc is wanting to bill 99363 for PT-INR management while patient is post-op w/ Home Health. Im concerned that this is included in the Plan of Care Certs & Recerts will already bill for (G0179 & G0180 or 99374 & 99375).
Does anyone have any helpful info? Basically he says he is taking the time to manage the INR when the Home Health calls and he is the one adjusting the med. Any help????

 

[mmiciano]

Coumadin Management

We are managing our coumadin patients over the phone. We request lab and once we receive the result we call our patients for any changes or when the lab needs to be done again. We are currently not billing for these. Can we code the 99363 or 99364? When can we really bill these codes?

 

[mitchellde]

You cannot bill 99363, and 99364, for phone calls these are face to face with the physician or practitioner services. I have had no problems with Medicare paying for these in several states that I work with. The key to using these codes is the timing, you cannot be even one day shy of the 90 days. You cannot bill with phone call codes either as these must be initiated by the patient and are non chargable if there is an office encounter in the past 7 days, therefore you cannot charge for this service.

 

[kbarron]

We have nurses in our office doing the 85610 QW, 36415, and 99211. I have another post regarding this. I am told that they are using the 211 because there is a change, and that the MD is also seeing the pt to change medication. I have asked for the note and none has come forth yet. Very confusing to me. I am only a coder not a Doctor.

 

[mnk8383]

I have read that both non face to face services and face to face visits are included and that telephone calls and electronic communications should not be reported seperately.