Conquer In-Office Coumadin Coding, Easy as 1-2-3
Posted on 21. Aug, 2009 by 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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