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99211 w/85610 and 36416

  1. Default
    Medical Coding Books
    is it allowable to charge 99211 with modifier 25 and 36415 when we are monitoring protimes in our internal medicine office. We are keeping a log of bp, dosage, and results for doctors to review and instruct on for each patient.

  2. #12
    Of interest, Healthcare Business Monthly April 2015 pp. 26 & 27 lists 2 examples of visits and says they are not billable as 99211. Both examples are listed on Debra's source doc as "generally billable" (notice the author couches with generally billable & not billable) & this 4/2015 article says no. One is the UA with prescription & the other is a patient who had a medication change d/t results of a test. Also, you have to be careful about that dressing change for injury because it could be post-procedural care for an injury under a global period. It is very confusing.
    Linda Tonyes RDN, LDN, CPC-A

  3. #13
    Columbia, MO
    FYI. There has been a span of ten years from when the article I post was authored and this Healthcare Business Weekly article was posted. A lot has changed in those ten years.

    Debra A. Mitchell, MSPH, CPC-H

  4. Wink Thank you
    Thank you for the thoroughness of your responses. I have found many of your posts extremely helpful for my job. I've been coding for 3 years, but I continue to learn something new all the time. In my practice we do use the 99211 and I have always found it to be used appropriately.

  5. #15
    This is old from the AAFP but I still think the info is useful ... Hope this helps!

    Prothrombin time testing with 99211


    I am considering adding CLIA-waived fingerstick prothrombin time testing to my outpatient clinic services. In addition to charging for the fingerstick (36416) and the test (85610), can I also bill a level-I office visit to cover my nurse's involvement in obtaining the specimen, running the test, processing the results and adjusting the warfarin dose?


    It depends. If your nurse provides a medically necessary E/M service to the patient and if your payer has a policy that allows the reporting of E/M services by nurses under the supervision of a physician (e.g., Medicare's incident-to billing rule), you may report a 99211 in addition to 36416 and 85610. Check with your private payers to determine whether they have an incident-to rule in place.

    Reports from Medicare audit contractors have noted that the documentation for these types of visits often fails to indicate medically necessary E/M services, which has led to the denial of 99211 services. To meet the requirements for a 99211 visit, nurses should document the reason for the visit, changes in the patient's history, medications or diet, instructions for continuing the physician's plan of treatment, and any discussion that occurs. For more guidance, see ?Understanding When to Use 99211,? FPM, June 2004, and ?The Ins and Outs of ?Incident-To? Reimbursement,? FPM, November/December 2001.

    You should also check which payers reimburse anticoagulation management under codes 99363 (for the first 90 days of therapy) and 99364 (for each subsequent 90 days of therapy). These codes include the physician review and interpretation of test results, patient instructions, dosage adjustment (as needed) and ordering of additional tests. When reporting 99363 and 99364, you may not report an E/M office visit code. (Note that Medicare does not reimburse the anticoagulation management codes in 2007, and the proposed rule for 2008 still lists them as noncovered.)

  6. Default 99211 guidelines
    Hi All,

    Are these guidelines for 99211 still in effect. Setting up a Nurse template and would like to be clear on what is billable for a 99211.

    thank you

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