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99211 Anticoagulation managment

  1. #1
    Cool 99211 Anticoagulation managment
    Medical Coding Books
    Ok. Anyone... please give my some advice on this one.
    In a physicians office with a Pharm D. doing anticoagulation management visits. Following all of the incident to guidelines. They want to bill a 99211 for every protime check. They do the PT/INR, BP check, ask them about their diet, any bruising or bleeding problems, change in medications, re educate them on rules while on the medication and then change the dose if necessary. Is it right to bill a 99211 for all of them?

    Anyone have a setup like this outside of the hospital?

    Heather

  2. #2
    Default
    If a Medical Assistant or Nurse did all of that you would bill a 99211 so why not for a Pharm? Hey if the Dr. was doing it you could bill a 99213 at least.

    Kathy

  3. #3
    Default
    If the pharmacist is providing this service look at MTMS (medication therapy management services) 99605-99607, based on time.

  4. #4
    Default anticoag cpts
    you should be using the 99363 and 99364 codes.

  5. #5
    Default
    99363 and 99364 are not Medicare covered codes. And I know Medicare isn't covering the Pharm. D. Codes yet either. It would help greatly if they were!

    Our concern is:

    Is it MEDICALLY NECESSARY EVERY TIME TO BILL A 99211?

    Can medical necessity really be met every time. I been hearing that Medicare is re couping their payments from practices doing this. Anyone else hear about this?

  6. Default
    This has been a back and fourth issue with our practice and I can never seem to get anything definite. We were billing 99211 for our NP to do PT/INR test strips, dose change, discussion, etc. but I went to an AAPC seminar last year and the CPC said that it is NOT appropriate to bill 99211 for every visit. The more I have looked in to it, I think it would be appropriate to bill a 99211 in certain cases (as long as you have appropriate documentation) but you should be using the 99363-99364 coumadin management codes. We have been using these codes--you are right, they are non-covered bundled codes with Medicare. It's a huge pain but some insurances pay for them (except UHC for us). Good luck! I would love any additional advice people have to offer.

  7. #7
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Unhappy
    We have folks come in for their anticoagulation chk and there is a charge for 85610 and 36416 with the 99211. These are not done in the home. Where is the MLM that I can reference stating what requirements are to be met for this 99211. Tired of the argument that you cannot charge for the 99211 for every pt that comes in.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
    Location
    Evansville Indiana
    Posts
    451
    Default 99211
    At a seminar given by a CMS consultant, she stated that Medicare does not expect to see 99211 at every visit. She stated that it should be used only when medically necessary, such as when there are new signs or symptoms reported by the patient or a change in medication dosage.

  9. #9
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Is there a med learn matters to back up this statement.. We need to have proof in writing.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  10. #10
    Location
    Evansville Indiana
    Posts
    451
    Default 99211
    The consultant gave The National Government Services - Medicare Part B Bulletin September 2004 as her reference. She stated that if the patient has no new symptoms or does not require a dosage change, the physician cannot report 99211.

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