Anticoagulation management

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Chesapeake, VA
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Can anyone help me out with this question? Can 99211 and 85610 be billed to medicare? I have had several different opinions. My docs tell me that we should bill both because medical decision making is required. Can we bill both if there is no cahnge to medication? Thanks Judy
 

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Local Chapter Officer
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Columbus, OH
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http://www.palmettogba.com/palmetto... Help Center~8525746A00550AA3852573E00075AC1F

This link is from Palmetto GBA.. Below is the info.. If the patient is coming for just the monitoring then no, only the 86510 may be submitted. They state "This is the same as for any other medication used in disease management. CPT code 99211 may not be routinely submitted for monitoring anticoagulation management."

Anticoagulation management services are inherent in the services captured by the E/M codes for management of the underlying condition for which the anticoagulation is medically necessary. This is the same as for any other medication used in disease management. CPT code 99211 may not be routinely submitted for monitoring anticoagulation management. Rather, any E/M service submitted, including CPT code 99211 must be medically necessary and supported by the extent of the history, exam, and medical decision making documented for the visit.

The following are examples of when CPT 99211 may not be submitted for Anticoagulation Management (this list is not all inclusive):

*When the in-person encounter with the patient was only for the diagnostic test
*For telephone care (this includes instructions on changing dose, assessment and/or education)
*When the only documentation would be vital signs, the patient's current and future dose of anticoagulant, and when lab work is to be reported
*When direct physician supervision requirements are not met or were not provided by the physician treating the patient's medical problem requiring anticoagulant therapy
*For repetitive education that does not serve the medical needs of the individual patient
 
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