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coumadin clinic

jenna

New
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4
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0
I am inquiring for a cardiology practice regarding the proper cpt codes to use when doing a coumadin clinic in the office.
My understanding is the MA will be checking the protime, vitals, weight, and reviewing current medications. Then the chart will then be reveiwed by the physician, he will make any adjustments. The MA will then go back into the room and inform the patient. The doctor will not see the patient.
Does anyone know the proper cpt codes to use? Any help would be appreciated. Thanks
 

heatheralayna

Networker
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64
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0
Anticoag managemenet

We charge the 99211 for the nurse's visit and the 85610 (QW) for our coumadin clinic.

What I am wondering about is the 99363 or 99364 codes. Should we (can we) be billing for these? I know we charge for them when patients get their PT done at an outside lab, but what about done in our office? Does anyone have input on this?

Thanks!

Heather
 

jerseygirl66

Networker
Messages
45
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0
99363 or 99364 are status B codes: Medicare considers them inclusive to any E&M. Managed care carriers vary, you need to check with them.

Also 99211 has been a target of CERT audits. Make sure you have documentation to justify the billing of 99211. If the patient is just getting a fingerstick and no medication adjustment is needed, no counseling provided or history etc, a 99211 is not warranted.
 

heatheralayna

Networker
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64
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0
ahhh... that makes sense.

The patient always get the INR reviewed by the MD and called back by the nurse, even if the dose is to remain the same.

Vitals are taken, pulse, etc. They complete a brief update form on meds, illness, etc. Do you think we would be covered?

I so appreciate your expertise! Thanks!
 

maysons1703

Networker
Messages
79
Location
Temple
Best answers
0
I agree, CPT states that any period less than 60 comtinous outpatient days is not reported with the use of anitcoagulant managment services (99363-99364), unless seperate identifiable service is perormed. Which it does not sound like it was.
 

jerseygirl66

Networker
Messages
45
Best answers
0
ahhh... that makes sense.

The patient always get the INR reviewed by the MD and called back by the nurse, even if the dose is to remain the same.

Vitals are taken, pulse, etc. They complete a brief update form on meds, illness, etc. Do you think we would be covered?

I so appreciate your expertise! Thanks!
Sounds like you may have all your bases covered but until you get a CERT audit, you really don't know.
 
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