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PT/INR-Coumadin Clinic...Help!!!

  1. Default PT/INR-Coumadin Clinic...Help!!!
    Medical Coding Books
    Hi,
    I am lost on the "Anticoagulant Management" CPT codes 99363 and 99364. For example, 99363 states "...outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment, and ordering of additional test; initial 90 days of thereapy (must include a min of 8 INR measurements). This all makes sense but how do you post and bill these charges? Do you just bill 99363 using last date of service at the end of the 90 days? I don't see how you could bill all DOS and wait to submit for 90 days, that would be past timely filing in some circumstances. Does anyone know how to bill for these codes??
    Any assistance or interpretation would be greatly appreciated!
    Thanks,
    Megan Barber, CPC

  2. Default
    Some insurance carriers are reimbursing these codes. In Michigan, Medicare is not. If a provider wants to use them for Medicare patients, then a NEMB (Notice of Exclusion from Medicare Benefits) form (found at
    http://www.cms.hhs.gov/BNI/Downloads...007English.pdf) must be given to Medicare patients prior to providing the services, and for non-Medicare patient's a letter advising they will be responsible out-of-pocket for the amount due, if their insurance doesn't pay.

    Also, per CCI, 99363 and 99364 are considered bundled into any other service that is billed on the same day, so we can't bill the insurance, or the patient out-of-pocket, if we're billing anything else.

    In Michigan, the only carrier I'm positive is currently covering these codes is BCBSM. Medicare, Medicaid, and SPHN/PHP TPA are definitely not covering these.

    99363 is for billing anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements). This isn't for face-to-face services and it's only for physician review, not for non-physician practitioners (unless billing under their own ID number), or for nurse review or other ancillary staff. This also cannot be used as part of care plan oversight services time.

    99364 is for billing anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of three INR measurements). This also isn't for face-to-face services and it's only for physician review, not for non-physician practitioners (unless billing under their own ID number), or for nurse review or other ancillary staff. This also cannot be used as part of care plan oversight services time.

    Yes, the last date of service is when each of these are billed, with that date in the to and from boxes. Rational for that is, it can't be billed any sooner because if for some reason the appropriate number of tests aren't completed during the time-period, then it shouldn't be billed at all, e.g., the patient dies, or the provider is no longer in practice or no longer able to treat the patient, etc.

    What carriers are requiring claims to be submitted prior to 90 days from the date of service? I'm not aware of any in my area with that file-limit, so just asking in case I've missed something I should know about.

    Kris

  3. Default warfarin
    Thank you very much for your input on my coding dilemma. I am still confused with these codes. I understand that Medicare will not pay for them but some carriers will. My main concern is that we're billing the correct code for the services we provide.

    Our NP sits down with the patient, does the fingerstick, review and interpretation of INR. We bill 36416 for fingerstick and 85610qw for prothrombin time but neither of these codes cover the work of the NP.

    You mention that this code is not for face-to-face time but in our case, the anticoagulant management is done face-to-face. The guidelines for 2008 specifically say that "...the work of anticoagulant management may not be used as a basis for reporting an evaluation and management service". You also mention that this isn't for NPPs. What I get from this is that besides the 2 codes we've been using (mentioned above), there really isn't a code that works in our case.

    As far as the mention of 90 days timely filing, I was speaking about the timely filing for general claims within 90 days of date of service (not prior to).

    Thanks again,
    Megan

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