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Thread: 99364 Anticoagulant Management

  1. #1
    Join Date
    Apr 2007
    East Valley Kachina Coders

    Unhappy 99364 Anticoagulant Management

    AAPC: Back to School
    How do I get paid for the 99364 Anticoagulant Management? Is there a modifier that needs to be used?

  2. #2
    Join Date
    Apr 2007
    Jacksonville Florida Chapter


    I really don't see anything in the guidelines that says you have to use a modifer with that code. Has your provider documented at least 90 continous outpatient days of thearpy? That's the only reason I can think of at this time that you're getting the denial.
    John Meyer, CPC-A
    Heekin Orthopedic Specialists

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    Medicare and many other payers stated early on that 99363 or 99364 would not be paid on the same day as an office visit even with a 25 modifier. So it needs to be a stand alone service, needs to be performed by the physician/NP/PA, and must be 90 days from the previous 99363 or 99364 and you must have a minimum of 3 PT/INR results, If you have all of this and are still not being paid what is the denial reading? Also the dx code we have been using is V58.83 and V58.61 and we have had not problems being reimbursed. Timing can be a problem though because 90 days is 90 days and cannot be anything short of.

    Debra A. Mitchell, MSPH, CPC-H

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