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-   -   PT/INR Monitering (http://www.aapc.com/memberarea/forums/showthread.php?t=29845)

loughary 01-28-2010 08:49 AM

PT/INR Monitering
Hi Everyone,

I was looking in the coding book and found two codes for PT/INR monitering and ordering of medicines. They are 99363 and 99364. Has anyone every used this codes? If so can you please let me know how you go about billing this...

We are a cardiology practice who has about 100 patients on coumadin and we call them the previous day with orders from the doctor and then also call in coumadin medicine to pharmacy.

Please help in anyway.


Tina Loughary

mitchellde 01-28-2010 09:03 AM

These are for physician face to face with patient encounters. Medicare's unadjusted rate last year was $104 for the 99363 and 40 for the 99364. You need to read up on these to know how to use them. cliff notes version. The initial encounter to give the dx and order the coumadin is day 1 and 90 days from day 1 with a minimum of 8 PT/INR results on the chart you can bill a 99363 for a physician encounter. Then 90 days from that encounter with minimum of 3 PT/INR results you may bill a 99364 for a physician encounter, and then a 99364 for each 90 days after. If the therapy is stopped for any reason then when it is restarted that encounter is day 1 and the whole process begins again.

heatheralayna 02-03-2010 11:50 AM

We bill them as appropriate, what Debra said, is all true. But, (always a But), just because it is in the code book many insurance do NOT pay for them. aka Medicare does not cover. Yet, some do, you have to weigh if it is all worth it for you.

evanasse 02-23-2010 09:11 AM

Hi Heather, Do you know what insurances will cover the 99363 and 64?

qljade1 03-04-2010 10:40 AM

we bill 85610. hmo plans will not pay have to go to outside lab. other then that we get paid.

mitchellde 03-04-2010 10:47 AM

I have not had any problem with Medicare reimbursing for these codes are you getting a denial that states it is not covered?

qljade1 03-04-2010 11:15 AM

mitchellde if you are asking me....

yes we get denials from bcbs hmo, oxford hmo. straight mcare does pay. denial is non covered service, must go to outside lab.

mitchellde 03-04-2010 11:40 AM

that is for the lab code, what about the 99363-4 I have never been denied by carrier. I have been asked for the documentation but have always received the reimbursement.

qljade1 03-08-2010 12:06 PM

what's the differance between the 99393 99394 or using the 85610 beside reimbursment??? kinda new at cardiology coding and only know of the 85610.

mitchellde 03-08-2010 03:40 PM

the 85610 is for the lab and 99393-4 is the physician face to face with the patient.

qljade1 03-09-2010 03:21 PM

that was my interpretation of it. thanks. our dr's do not do the test, the clinical staff does.

qljade1 03-09-2010 03:22 PM

can you bill 99393-4 with an office visit??

mitchellde 03-09-2010 03:24 PM


Originally Posted by qljade1 (Post 99765)
can you bill 99393-4 with an office visit??

The way the AMA designed it yes, however early on with this set of codes CMS sent a memo that stated that even with a 25 modifier and different dx they will not pay for both an OV and the anticoag monitoring, they will pay the lesser of the 2 and other carriers followed suit. So advice is I would not.

qljade1 03-11-2010 12:46 PM

would you think you could bill both codes? 85610 and 99393-4?

qljade1 03-11-2010 12:59 PM

and i really mean 99363-4

taralyn1 04-07-2010 10:21 PM

We just started billing for PT/INR We were told to bill 99211(RN,sees the patient face to face)along with the code 85610. I was told not to use any modifier but we are not a lab, we do not have CLIA # which for that code know isn't needed but I thought I would need to use the modifier QW with the 85610.

Thank you please help:(

mitchellde 04-08-2010 05:30 AM

You cannot bill a 99211 for the nurse to draw blood even with vital signs.

taralyn1 04-08-2010 11:44 PM

its not a blood draw just a lancet is used not a blood draw w/needle. The blood is put then on a slide and read by the nurse. I hope this makes more sensce. This whole thing is making me nervous reck. Does there still need to be a QW modifier put on the86150?

Thanks for your time I really appreciate:(:)

mitchellde 04-09-2010 07:44 AM

You still may not use a 99211. and yes I believe the QW must be there.

taralyn1 04-11-2010 09:26 PM

Thank you all for your help

AshleyMartin 04-12-2010 03:55 PM

Well bill 99211 for our Coumadin Clinic along with 85610-QW. A medical assistance does the office visit along with the finger stick and the 99211 is covered under the "incident to" rule. One physician is in the office suite at all times.

mitchellde 04-12-2010 08:16 PM

I still disagree with the use of the 99211. The patient is there for a scheduled procedure if you will. The 36415-6. When a CPT code exists for the service ordered to be performed then thst is the code we must use. You cannot code a 99211 with the 36415-6 so there for you may not use the 99211. The service is incident to I agree but there is a code for the service ordered and performed.

Lisa Bledsoe 04-13-2010 08:55 AM

If a patient comes in for a routine protime for which they see the nurse who does the appropriate evaluation and documentation, pricks the finger, documents results, discusses with MD any change in dosage, again documents appropriately; in my opinion this qualifies for 99211.

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