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Thread: Protime in office

  1. #1

    Question Protime in office

    AAPC: Back to School
    Can anyone tell me and give me a link to how exactly to bill Medicare for Protime done in the office on a machine we own?

  2. #2
    Join Date
    Apr 2007
    Lebanon, NH


    We bill PT/INRs all the time to Medicare, however we are FQHC so we are not allowed to bill the nurse visit in conjunction with the test, so we bill only the test. Here is what we use:

    Dx: v58.61 (Patient visit for long-term use of anti-coagulants)
    CPT: 85610-QW -- PT/INR

    To all other insurance companies, we bill the same, but have a nurse visit charge attached as well (99211) -- but because we are FQHC we have to write-off this charge on Medicare claims as "non-billable"

    Hope this helps

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    You should not bill a 99211 when the purpose of the encounter is a PT/INR a code exists for the blood collection and you should use that 36415 or 36416 plus the 85610 QW. The V58.61 was deemed a secondary only allowable code in 2003 so the appropriate is the one that matches the reason for the encounter which is drug monitoring so use the V58.83 and the V58.61 secondary.

    One good source for this is a Decision Health article written by Katleen Mueller who was the Compliance officer for CMS written Feb 11 2002.
    Last edited by mitchellde; 12-20-2011 at 09:38 AM.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007
    Evansville Indiana

    Default 99211

    NGS allows the 99211 with the 85610 if and only if there is a change in meds, or new symptom. There must be documentation of the counseling, findings, etc and it must meet incident to guidelines.

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