Wiki Coumadin Clinic

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M.Mohler

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So our clinic is Family Practice and we want to start a Coumadin Clinic. If the patient comes into the clinic and sees a physician for a Coumadin check where they will do the Prothrombin time, reviewing the results and educating the patient on treatment/lifestyle and they have the 3 elements (history, exam, mdm) can we bill out a 99212? I keep looking at the Anticoagulant Management codes (99363, 99364) and am getting confused. We have been researching this and cannot seem to come to an accurate conclusion. It seems that others will use a 99211 with the 85610 but we plan on having the patient see the physician.
 
The 99363-4 are codes to be used every 90 days for exactly what you are talking about doing. you do not charge a 99211 for a blood draw encounter. If you need more info on how to use the 99363-4 you can send me a PM.
 
Pamela Drgos, CPC

Our office bills a 99211 if the rx is changed because of pt results. Nurse needs to consult w/dr and call pt.
 
I know a lot of offices do this but it has been stated that you may not bill a 99211 for the patient to come into the office for a blood draw encounter.
Feb 18 2002 CMS did a report for Decision health which stated that IF you wanted to calle this a coumadin encounter and bill a 99211 then the nurse must document:
vital signs
a thourough exam of the patient to check for bruising
a review with the patient of all current medications
a review with the patient regarding their diet
the past PT result
todays PT result
the discussion with the physician
the discussion with the patient regarding any change
BUT all must be face to face with the patient and none over the phone.
 
Ok so a no for the nurse unless they have an extensive visit but what about the patient seeing the doctor? Does this fall into the anticoagulant management codes or could we bill a low office visit (99212)?
 
I just really feel that this falls into the same category as an injection and an office visit. We told the patient what to come in for and they draw the blood, even if the physician says hello and asks questions it was still a visit for the blood draw. I say no to the physician level as well.
 
supplies/unbundling

At my providers office they insist on billing for needles, gloves and other unpaid supplies. Any suggestions on how to tell them we can't do that so they will stop thinking it is ok? I have tried but she insists that she is right since UHC pays for them!

They want to bill: 85610, 36415, A4212, A4927?? Oh and don't forget the 99212. :(
 
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