AAPC - August DL Sale: 50% OFF
Results 1 to 4 of 4

Thread: Pt/inr

  1. #1
    Join Date
    Apr 2007
    Location
    Savannah, GA
    Posts
    28

    Lightbulb Pt/inr

    Just looking for a little advice...
    I have instructed my nurses that they are to bill a nurse visit only when the patient's coumadin level is off and the physician is required to review and adjust their medication. The problem I have now is that patient's are upset because they are being billed the copay for these visits. They state they did not see the physician so they should not be billed for an office visit. I have tried to explain that even though they are not seeing the physician, the physician is required to review, adjust and provide instruction on their medication if their coumadin level is off. Is anyone else having these confrontations with patients? and if so how is your office handling it?

  2. #2
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,068

    Default

    You are not to bill a 99211 for a nurse to draw blood to check for a pt/inr level. If the level is off the nurse cannot bill to be the one to tell the patient how to adjust the medication, because you do not meet the requirements for incident to in this respect.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Location
    Savannah, GA
    Posts
    28

    Default

    From my understanding this scenario is billed as a 99211 and 85610-QW

    The nurse is not adjusting the medication, the physician is in the office which meets the "incident to".
    If the level is off, the nurse shows the results to the physician while the patient is still in the office.
    the levels indicate a change is needed in the anticoagulant dosage which meets the "medical necessity"
    the physican gives instructions to the nurse who in turn informs the patient while the patient is in the office which meets the "face-to-face requirement" and everything that was done is properly documented in the patient's chart.

    Now if the patient comes in for a pt/inr and levels are where they should be, we are only billing an 85610-QW

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,068

    Default

    In order for incident to to be met the physician must see the patient for the same dx... which I can see your point they have and they have ordered for the followup encounter, however as soon as the physician determines that the meds need to be adjusted the the original plan of care no longer applies and that is the plan of care this visit is based on. So to bill a 99211 now the physician will need to visit with the patient to explain the med adjustment as a new plan of care.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Pt/inr
    By medgington in forum Diagnosis Coding
    Replies: 1
    Last Post: 05-10-2012, 02:19 PM
  2. Pt/inr
    By cvand1972 in forum Pathology & Clinical Laboratory
    Replies: 1
    Last Post: 02-18-2011, 01:44 PM
  3. Inr
    By PLAIDMAN in forum Pathology & Clinical Laboratory
    Replies: 1
    Last Post: 08-05-2010, 12:00 PM
  4. E/m on pt/inr
    By hsmith67 in forum E/M
    Replies: 2
    Last Post: 05-13-2010, 07:15 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.