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Thread: pt/inr question

  1. #1
    Join Date
    Apr 2007
    Posts
    52

    Post pt/inr question

    AAPC: CPC Promo
    I am in need of someone's point of view on this situation. I work at a facility in which we have many patient's that have standing orders for PT/INR, and Coumadin Therapy. Most generally the Drs. give us the diagnosis as to why they are on the Coumadin and getting the PT checked, so we have been coding these cases with the diagnosis given and the Long Term Med. Mtr. diags. (ie. 453.9 and V58.61). It has come to my attention that we should not be coding it in this way, but instead using the V58.83 then the V58.61 (encounter for therapuetic drug monitoring, then the long term mtr. code) is this correct? And also would it be incorrect to include the actual problem as to why there are on the meds?
    I have read the Coding Clinics, 2Q2004 pg. 10-11, and Coding Clinic 3Q2002, pg. 15-16, but they do not seem to get a specific scenario. Any guidance would be much appreciated

  2. #2

    Question Pt/INR question

    Did you ever get any answers to this question. I would like to know how we code this also. Do we use Primary diagnosis, then V58.61, continuously for the INR therapy? Also, can we use the 90862 Medication management code for the services? Thank you.

  3. #3
    Join Date
    Apr 2007
    Location
    York, Pa
    Posts
    1,901

    Default

    Quote Originally Posted by ruthan View Post
    I am in need of someone's point of view on this situation. I work at a facility in which we have many patient's that have standing orders for PT/INR, and Coumadin Therapy. Most generally the Drs. give us the diagnosis as to why they are on the Coumadin and getting the PT checked, so we have been coding these cases with the diagnosis given and the Long Term Med. Mtr. diags. (ie. 453.9 and V58.61). It has come to my attention that we should not be coding it in this way, but instead using the V58.83 then the V58.61 (encounter for therapuetic drug monitoring, then the long term mtr. code) is this correct? And also would it be incorrect to include the actual problem as to why there are on the meds?
    I have read the Coding Clinics, 2Q2004 pg. 10-11, and Coding Clinic 3Q2002, pg. 15-16, but they do not seem to get a specific scenario. Any guidance would be much appreciated
    We have always coded it as such.... the reason pt is on coumadin then the
    V58.61, we have not had any issues. I hope we get some more takers on this question.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  4. #4
    Join Date
    Apr 2007
    Location
    Kokomo, IN
    Posts
    769

    Default pt/inr

    I code it both ways depending: If the physician gives me a reason for the patient being on coumadin, I use this as the primary, then the V58.61, I do not use the V58.83 in this instance. If the physician says they are on coumadin therapy and does not give me a reason, then I add the V58.83 and use the V58.61 as secondary. We started doing that when we were no longer allowed to use the V58.6x codes as primary.
    Hope this helps.

  5. #5

    Default Pt/inr

    We will soon be opening a Coag Clinic and I found a question/response about the use of these codes. It says the V58.83 is used first to indicate the Encounter for therapeutic drug monitoring, followed by the V58.61 . This could be followed by a history code such as V12.5x if documented.
    I think if the condition still exists you would not use the V58.83...it is not monitoring...seems more like active therapy.
    I am glad to ready your input on these scenarios!

  6. #6
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    604

    Default

    What about a pt who has PT/INR done at the same time as a medical visit. Would you put 25 on the office visit as this really had nothing to do with the nature of visit.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  7. #7

    Default

    We usually code as follows: dx (such as 424.1 or 427.31) + V58.61 and/or V58.83 - the 85610 needs to have a QW mod. With coding this way we never have them deny. Also, if using an E/M on the same date add a 25 mod to the E/M. (If not see a phys and the pt was counseled ref their coumadin then you can add a 99211 w/o the 25 mod)

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