Pt/inr - I have instructed my nurse

[jnieto625]

Just looking for a little advice...
I have instructed my nurses that they are to bill a nurse visit only when the patient's coumadin level is off and the physician is required to review and adjust their medication. The problem I have now is that patient's are upset because they are being billed the copay for these visits. They state they did not see the physician so they should not be billed for an office visit. I have tried to explain that even though they are not seeing the physician, the physician is required to review, adjust and provide instruction on their medication if their coumadin level is off. Is anyone else having these confrontations with patients? and if so how is your office handling it?

 

[mitchellde]

You are not to bill a 99211 for a nurse to draw blood to check for a pt/inr level. If the level is off the nurse cannot bill to be the one to tell the patient how to adjust the medication, because you do not meet the requirements for incident to in this respect.

 

[jnieto625]

From my understanding this scenario is billed as a 99211 and 85610-QW

The nurse is not adjusting the medication, the physician is in the office which meets the "incident to".
If the level is off, the nurse shows the results to the physician while the patient is still in the office.
the levels indicate a change is needed in the anticoagulant dosage which meets the "medical necessity"
the physican gives instructions to the nurse who in turn informs the patient while the patient is in the office which meets the "face-to-face requirement" and everything that was done is properly documented in the patient's chart.

Now if the patient comes in for a pt/inr and levels are where they should be, we are only billing an 85610-QW

 

[mitchellde]

In order for incident to to be met the physician must see the patient for the same dx... which I can see your point they have and they have ordered for the followup encounter, however as soon as the physician determines that the meds need to be adjusted the the original plan of care no longer applies and that is the plan of care this visit is based on. So to bill a 99211 now the physician will need to visit with the patient to explain the med adjustment as a new plan of care.