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Medication Monitoring

  1. Question Medication Monitoring
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    If one of our doc's is having a patient come in once a week to monitor their Coumadin level's / possibly adjust amounts - what would a CPT code be for this...???

  2. #2
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    Is this a blood draw encounter and the physician calls the patient with the result? If so this is a blood draw only 36415-6

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    No, the doc would only be going over the result with the patient only face to face. The lab would have been done prior to the appt day. This is being done on a weekly basis, so far..

  4. #4
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    This is how we do it. Patients come in weekly or monthly to have their INR checked. They see lab for the draw. Lab gives the result to the doctor's nurse. A nurse will go in and take the patients bp and pulse. The nurse has the patient wait in the room and goes and grabs the doctor. The doc stops in quickly and tells the patient what to do with their coumadin dosage and when to have it checked next. This all happens pretty quickly and efficently. We then bill a 99211 (with dx for coumadin, such as A-fib 427.31), then 85610 and 36415 for the draw (dx code V58.61). If the doctor does not see the patient on the day of the draw then you can only bill for the 36415 and 85610. Even if the patient sees the doctor the next day you will have to bundle it into the
    E & M on the next day when he address it at pts appt. Sorry about my loooog answer.

  5. #5
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    Columbia, MO
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    Quote Originally Posted by nneecole View Post
    This is how we do it. Patients come in weekly or monthly to have their INR checked. They see lab for the draw. Lab gives the result to the doctor's nurse. A nurse will go in and take the patients bp and pulse. The nurse has the patient wait in the room and goes and grabs the doctor. The doc stops in quickly and tells the patient what to do with their coumadin dosage and when to have it checked next. This all happens pretty quickly and efficently. We then bill a 99211 (with dx for coumadin, such as A-fib 427.31), then 85610 and 36415 for the draw (dx code V58.61). If the doctor does not see the patient on the day of the draw then you can only bill for the 36415 and 85610. Even if the patient sees the doctor the next day you will have to bundle it into the
    E & M on the next day when he address it at pts appt. Sorry about my loooog answer.
    Does the physician document the encounter? If he does not then I disagree with charging a 99211 just because he stops in quickly. The dx for the encounter and the lab should be V58.83 first then the V58.61 and then the 427.31. The patient is here for drug monitoring not for the a fib.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by mitchellde View Post
    Does the physician document the encounter? If he does not then I disagree with charging a 99211 just because he stops in quickly. The dx for the encounter and the lab should be V58.83 first then the V58.61 and then the 427.31. The patient is here for drug monitoring not for the a fib.
    I agree with Debra on this one..... I too work in FP and we see pt's for their Protimes, we only charge the blood draw fee and lab test code.

    We have however starting using the codes for Anti- coagulation managment 99363-99364. There are specific guidelines in billing for this. I am wondering if you read your cpt book for these two codes your docs might want to start using them. Although not all carriers pay or allow for these two codes it is pretty much capturing what "your physicians" are trying to in billing a 99211.

    Good luck!
    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"

  7. #7
    Default 99211
    Just when I think 99211 is clear in my mind, something comes up AGAIN to make me question it.

    We charge a nurses visit for our lab work. The nurse will take the pateints B/P, weight and do a pulse ox on the patient. With the INR's I feel it is even more appropriate that we charge a 99211 because whether we do the INR in house or send it out, the Doctor is still required to look at the results, document any changes if any in the patient chart, he/she will either call the patient or have their nurse call the patient. This is all time consuming and I would think that the little they pay for a 99211 that this would all be inclusive for that visit.

    This also goes for lab work done that the patient DOESNT want to come back in, they want the Dr. to call them with the results.

    I was talking to a Medical Auditor that taught our CPC class and she said that all we needed to do to bill out a 99211 is to document the weight, and B/P. We have done this for years and I have felt comfortable billing the insurance for it. It the nurse DOES NOT document anything, the only thing we bill is the veinupuncture.

    Is this what others understanding is?

  8. #8
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    Just doing vitals signs is not a 99211. This is activity that is integral to the encounter the patient was told to come in for which was the blood draw. They have no complaint and the nurse is following orders from the physician do do the blood draw. This is all inclusive to the blood draw code. To use the 99211 for a nurse encounter the activity must previously been ordered by the physician and there is no other CPT code available to capture the activity ordered and performed, and of course the physician must be in the office suite area. Since a code exists for the blood draw that is what must be used.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default 99211
    Hi Debra,

    Thanks for taking the time to reply. I think the definition of the 99211 should read something different then. It states, Office or other outpatient visit for the DE/m of an est pat, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically 5 minutes are spent performing or supervising these services.

    The way we look at it is that the nurse is caring for the patient, making sure the right labs are drawn and the correct ICD9 code goes to match, documents everything in the chart, puts the lab orders where they need to go etc. There is a whole lot of work that goes into lab draws in an office setting both on the front end and back end, it doesnt stop at the veinpuncture site.

    I cant tell you the discussions that we have had over this issue. Again, thank you for taking the time to reply, I really appreciate it with Christmas right around the corner.

    Merry Christmas!

  10. Default 99211
    I agree with Gina.

    Even without the physician component this would qualify as a 99211. The blood draw CPT does not include the listed RN interaction. Things are always open to interpretation, but if the CPT language dictates it, then I agree with billing it.

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