Wiki Protimes in Office


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Our office is having troubles getting protimes being paid by Medicare. Our office has Medical Assistants, no nurses and we are doing the protimes in office. We have been billing the 85610 with the fingerstick (FS is done, not a venipuncture). Medicare is bundling the fingerstick and only paying for the 85610(protime). Any suggestions? --- does the protime need to have QW modifier-would that make a difference? any help would be appreciated.

Yes, you need the QW modifier since it is a CLIA waived test. Remember to have a referring physician as well on the claim.
I do not think the QW, while needed, will prevent the 36416 from bundling into the 85610. M care routinely will bundle the collection of the blood into the lab code as they feel it is the right thing to do since you could not run the lab without the specimen so it is an integral piece of the lab and cannot be separated.