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CarlaSoltis

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Hello Everyone:

I work for a PCP and we just recently started billing for PTINR's using 99363 and 99364. DX's are the primary reason for blood thinners and V58.61 and V58.83

We are getting all of our claims denied:


These are among some of the denials.


"Not covered when performed during the same session/date as a previously processed service for the patient"

"There is no allowable amount for the codes based on coding and billing guidelines. ( I know that I can appeal this one with a print out of the payers allowables)"

"This procedure is not payable separately"


Does anyone have any suggestions on how to get the two CPT's paid?
Do we need to add the two CPT's to our CLIA?

Thanks so much for all your help.
Carla
 
Our office performs the finger prick PT/INR in office and bills it with the code 85610-QW. We bill it with dx codes of v58.83 and v58.61 and have had no issues with getting paid. Hope this helps!
 
CarlaSoltis said:
Hello Everyone:

I work for a PCP and we just recently started billing for PTINR's using 99363 and 99364. DX's are the primary reason for blood thinners and V58.61 and V58.83

We are getting all of our claims denied:

These are among some of the denials.


"Not covered when performed during the same session/date as a previously processed service for the patient"

"There is no allowable amount for the codes based on coding and billing guidelines. ( I know that I can appeal this one with a print out of the payers allowables)"

"This procedure is not payable separately"


Does anyone have any suggestions on how to get the two CPT's paid?
Do we need to add the two CPT's to our CLIA?

Thanks so much for all your help.
Carla
Click to expand...

These are codes to be used for the provider encounter with the patient and have timing limitations. You must following the timing carefully and have the required number of PT INR results prior to each encounter. These are not for nursing only visits or for the lab. The CPT Changes book that came out when these were introduced is great for instructions on how to use these codes
 
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