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Anticoagulant Management

  1. #1
    Default Anticoagulant Management
    Medical Coding Books
    I have a practice that is billing 99211's in conjunction with the protimes. The nurses are documenting that they review the patient's labs, adjust the coumadin, and write rx's. It's hit or miss whether the insurance pays for both, usually they pay one or other.

    To me, 99363 and 99364 make more sense for these patients... the physician does review/interp the INR's...and the nurse takes care of the rest based on what the doc tells them. Any suggestions?


  2. #2
    Duluth, Minnesota
    we had this issue come up in our office early 2007 ! ... I can't recall the issues exactly but I know in the end we ended up continuing to code the same as always, with the 99211 & 85610QW (unless there was another office visit that day, then we didn't charge out the 99211).
    it has something to do with Medicare not covering the 99363/99364 separately, they say it's bundled into the E/M service. Also, if it was fewer than 8 INR's you can't use the 99363.. Another issue was the fact that the codes are only billed out once - (99363 at the end of the initial 90 days w/8 INRs and 99364 w/3 INRs at the end of the subsequent 90 days), and insurances hadn't decided what reimbursement was going to be.
    anyway - not much help (sorry)....
    but we are still using the 99211 for our protime patients. Actually, I don't think we run 8 INR's even within the first 90days. Maybe 2 the first month, and once a month after that - of course depending on their needs. There was a person a few months back that was in every 4 days for a time! ... but they got it under control.
    reimbursement is the same as it's always been. I'd be interested in how payment is if you use the codes though, it does make sense to use them!
    Donna, CPC, CPC-H

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