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Coumadin coding

  1. #1
    Default Coumadin coding
    Medical Coding Books
    I need some advice

    we have rn's who perform coag checks 85610qw. Are we allowed to bill for the the finger stick 36416? What is the customary charge for this service?

    I see that it is not a paying code on the mc fee schedule.

    Also what are your thoughts in regards to billing a 99211? What are your thoughts on the required documentation?

    With the advent of ehr are checking boxes enough?


  2. #2
    We bill the following:

    36415 - 59
    85610 - QW

    Please check with your carrier about billing 99211. Our region is covered by Highmark Medicare Services and we are only able to charge the 99211 if the medication needs adjustment, the INR is not therapeutic, or if the patient has symptoms that need to be addressed. The Doctor has to make a note indicating the adjustment in medication and sign off in the record for 99211.

    We are allowed to bill the 36415, but it must have a modifier 59 or our carrier will not process it for payment. Hope this helps!


  3. #3
    Columbia, MO
    You should not use the 99211 for a blood draw encounter as there is the code for that, the 36415 or 36416. For a nurse to see a patient that has symptoms or needs to address INR that is not in therapeutic range is out of her scope of licensure. A nurse is not licensed to evaluated a complaint and diagnose and treat it. This must be face to face with the physician.

    Debra A. Mitchell, MSPH, CPC-H

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