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Thread: 99211 and PT billing

  1. #1

    Default 99211 and PT billing

    AAPC: Back to School

    I just found out that we may have not been coding 99211 and PT billing correctly. Does anyone have any insight into this? We have a lot of patients on warfarin/coumadin and our previous billing person told us to always code a 99211 when these patients come in to get a blood draw. Looking at the literature doesn't really clarify it. It seems like a lot of gray areas.



  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If the patient comes in just for the blood draw then you may not use a 99211 for this activity it is a blood collection encounter and must be billed using the blood collection code. (36415, 36414) Just because vital signs may be taken does not qualify this encounter to be billed as a 99211.
    However per a decision health article written Feb 11 2002, the compliance office for CMS decided the following:
    If you are going to call this a "Coumadin encounter" then the following must be documented by the nursing staff (not as a flow sheet)
    * the patient's entire body must be checked for bruising (clothes off!)
    * the patient's diet must be discussed and the compliance to the doctor prescribe diet detailed
    * the patient's meds must be listed and the daily routine described and the patient compliance
    * the blood collection documented
    * the past PT and today's result documented
    * discussion with the physician regarding the result and patient compliance documented
    * any physician ordered change in medication and discussion with patient documented.
    All of this must be face to face with the patient THEN you may bill this as a 99211 and not use the blood collection code.
    This is a lot to document and it takes a lot of auditing to make sure they capture all the elements each time.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Thank you very much. It is really hard to decipher what Medicare wants. Really helpful.

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