Conquer In-Office Coumadin Coding, Easy as 1-2-3
Posted on 21. Aug, 2009 by admin in Hot Coding Topics
Tip: Watch how you support medical necessity for warfarin therapy. Here’s where many coders make the wrong ICD-9 choice.
Don’t get stuck with the bill for your physician’s in-office monitoring of Coumadin use — instead, learn the Coumadin coding ropes. One surefire way is to follow these 3 guidelines.
1. Put Proper Code to Periodic PT Test
“Physicians often use PT [prothrombin time] to assess patient response to the drug warfarin,” says Barb Miller, MT (ASCP) SH, with Nebraska Medical Center.
When patients on warfarin therapy come to your “Coumadin clinic” for periodic testing to assess their anticoagulation status, you should report 85610 (Prothrombin time) for the test.
Remember the modifier: Be sure to append modifier QW (CLIA waived test) to 85610 (and that you operate with a CLIA certificate of waiver).
If the nurse needs to evaluate new symptoms such as bruising or bleeding — something beyond the basic PT visit — code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician …) may be appropriate also.
Remember: Medicare doesn’t consider 99363 and 99364 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio [INR] testing, patient instructions, dosage adjustment [as needed], and ordering of additional tests …) to be payable codes under the physician fee schedule.
2. Pull Out V58.61 for Diagnosis “Patients may be on anticoagulation therapy for many reasons, but you should not report the underlying condition as the primary code for the PT test,” says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.
Do this: “If the...
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3 Responses to “Conquer In-Office Coumadin Coding, Easy as 1-2-3”
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Jessica Carriveau CPC, CCC
26. Aug, 2009
I disagree with the article stating to put V58.61 as the primary dx. ICD-9 clearly states that this is a secondary dx. You can’t report this as primary.
Ellen Garver
31. Aug, 2009
You are correct that ICD-9 lists V58.61 as a secondary diagnosis. But the article correctly states that you shouldn’t list first the underlying condition when the reason for the PT test is to monitor the effectiveness of anticoagulation medication.
A change to the laboratory NCD for prothrombin time (PT) now lists V58.83 (Encounter for therapeutic drug monitoring) as a covered diagnosis. ICD-9 instruction for that code says, “Use additional code for any associated long-term (current) drug use (V58.61-V58.69).”
If the reason for the PT test is to monitor the effectiveness of anticoagulation medication, the diagnosis coding for the service should be V58.83 followed by V58.61.
Ellen Garver, CPC
Editor, Pathology/Lab Coding Alert
Stephanie
25. Sep, 2009
I used V58.61 as secondary and 427.31 as primary and was denied because they want v58.61 as primary 427.31 as secondary. According to the letter we got, effective
09-01-09, it was changed on how we are supposed to bill.
My question is when we bill the 99211, we ask several questions like, any new bruising bleeding , RX changes, SOB, CP ect. I was recently told I need to start doing vitals in order to bill 99211 with PT/INR checks and dosage changes; is this true?