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Office visit and INR

  1. Default Office visit and INR
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    We billed 99214-25 and 85610QW and received a denial from medicare for the office visit. When we called them they said they need a different modifier. Am I missing something? Modifier 25 was attached to the charge...any ideas.

    Also, when we are billing the 99211-25 when appropriate and the 85610QW we have started getting denials for the INR. This just started in the last few months and I can't seem to find any new information on it. Any help would be appreciated.


  2. #2
    Columbia, MO
    Not sure on the 99214 but the 99211 you cannot bill when the purpose is for a blood draw you must bill the 36415-6 with the 85610QW.
    I do not know what modifier they could be referring to on the 99214 and quite honestly they may not know either. They are not allowed to tell you haow to bill a claim or line item for payment. If this is an encounter by the physician to montor the anticoagulation drugs then why not use a 99363 -4? That is what those codes are for providing the timing is correct. If the visit is for a different issue and you also did the INR then perhaps you dx linkage is incorrect. Also why not bill the 36415-6 in addition to the 99214?

    Debra A. Mitchell, MSPH, CPC-H

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