Re: Getting paid for Coumadin/Warfarin Management? CPT 99363, 99364

[Guest guest]

Found some RVU's for the Coumadin Management...looks like it pays better than one would think -- at least better than nothing - which is what outpatient (non-visit) management has paid in the past.CPT 99363 - Nonfacility - RVU 1.19 and fee $60.33

http://www.michigan.gov/documents/wca/10_EM_333596_7.pdf

Locke, MD

[Guest guest]

We do them in the office, although we've been having issues with our machine since our nurse left (CoaguChek XS).  We bill it as a 99211 + 85610-QW + 36416.  We do not get paid for the 36416.  We get reimbursed about $28-$29 total.

 

 

 

Anyone getting paid for monitoring INR's? Not testing in the office, but monitoring over phone.

99363             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INRmeasurements) 

How much on average?

One of my past contracts - now that I look it up -- says...

99363 - $192.8199364 - $67.25 Which seem surprisingly high.

Medicare doesn't seem to cover...when I search online for pricing.

No records found. This may be due to the fact that there are no records in the system for the HCPCS code(s) selected OR one or more of the selected codes is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts.

List of HCPCS Codes

Code

Description

99363

Anticoag mgmt init

99364

Anticoag mgmt subseq

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoIbillforCoumadincheck.pdf

FAQ – How do I bill for a Coumadin check?

Scenario:  Patients on anticoagulant medication, such as Coumadin, must be monitored closely.  

These patients typically present to the office or a laboratory for a blood draw for purposes of 

running a Prothrombin test.  This test may be done by the office or the lab.  

Coding:  When these patients present to the office for this prescheduled lab draw, in the absence 

of problematic signs/symptoms that warrant evaluation of a provider (MD, ARNP, PA), ONLY the 

lab draw and Prothrombin test (if performed in the office) may be billed.  It is not appropriate to 

also bill a 99211 E/M service in this scenario*.  However, there are now CPT codes available for 

reporting the management of the anticoagulant therapy: 

99363             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; initial 90 days 

of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; each 

subsequent 90 days of therapy (must include a minimum of 3 INR

measurements) 

These codes are only to be used in the outpatient setting and not to be reported if less than 60 

continuous outpatient days of therapy management have occurred.  These codes also do not 

require the face-to-face evaluation by a provider.  Therefore, the nurse may perform the blood 

draw, the test can be run and the communication of the results/dosage changes can be done by 

the nurse as well provided the billing provider documents their involvement with review of 

results and their management plan/changes.  The bill for the anticoagulant management 

should be submitted after the 90 day period and minimum INR measurements met using the 

provider number for the provider who has performed the majority of the management during the 

90 day period. 

*It is recognized that historically Coumadin services have been billed with CPT code 

99211.  This was the code that was determined to be most appropriate since there were 

no codes in existence describing the exact anticoagulant medication.  However, the 

anticoagulant medication codes should now be used.   

Note:  Anticoagulant medication therapy provided by a PharmD should be reported by 

using a Category III CPT code, created in 2006.  (0115T, 0116T or 0117T).   

Anticoagulant management CPT codes are relatively new and reimbursement may be 

difficult or even unobtainable from some payers.  Medicare and Medicaid do not yet cover 

these codes; however, since they are “non-covered” services, you may consider these 

services self-pay.  Working with the USPG Managed Care department would be useful to 

determine which other payers will reimburse. 

Locke, MD

-- Pratt

[Guest guest]

i used to do it how karen does when we were using the coag check machine in the officeif i'm not mistaken, kelly, you're talking about sending someone to the lab, making adjustments by phone/email and the billing insurance for that.  never have tried that but would definitely be interested if someone has done that and gotten paid

 

We do them in the office, although we've been having issues with our machine since our nurse left (CoaguChek XS).  We bill it as a 99211 + 85610-QW + 36416.  We do not get paid for the 36416.  We get reimbursed about $28-$29 total.

 

 

 

Anyone getting paid for monitoring INR's? Not testing in the office, but monitoring over phone.

99363             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INRmeasurements) 

How much on average?

One of my past contracts - now that I look it up -- says...

99363 - $192.8199364 - $67.25 Which seem surprisingly high.

Medicare doesn't seem to cover...when I search online for pricing.

No records found. This may be due to the fact that there are no records in the system for the HCPCS code(s) selected OR one or more of the selected codes is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts.

List of HCPCS Codes

Code

Description

99363

Anticoag mgmt init

99364

Anticoag mgmt subseq

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoIbillforCoumadincheck.pdf

FAQ – How do I bill for a Coumadin check?

Scenario:  Patients on anticoagulant medication, such as Coumadin, must be monitored closely.  

These patients typically present to the office or a laboratory for a blood draw for purposes of 

running a Prothrombin test.  This test may be done by the office or the lab.  

Coding:  When these patients present to the office for this prescheduled lab draw, in the absence 

of problematic signs/symptoms that warrant evaluation of a provider (MD, ARNP, PA), ONLY the 

lab draw and Prothrombin test (if performed in the office) may be billed.  It is not appropriate to 

also bill a 99211 E/M service in this scenario*.  However, there are now CPT codes available for 

reporting the management of the anticoagulant therapy: 

99363             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; initial 90 days 

of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; each 

subsequent 90 days of therapy (must include a minimum of 3 INR

measurements) 

These codes are only to be used in the outpatient setting and not to be reported if less than 60 

continuous outpatient days of therapy management have occurred.  These codes also do not 

require the face-to-face evaluation by a provider.  Therefore, the nurse may perform the blood 

draw, the test can be run and the communication of the results/dosage changes can be done by 

the nurse as well provided the billing provider documents their involvement with review of 

results and their management plan/changes.  The bill for the anticoagulant management 

should be submitted after the 90 day period and minimum INR measurements met using the 

provider number for the provider who has performed the majority of the management during the 

90 day period. 

*It is recognized that historically Coumadin services have been billed with CPT code 

99211.  This was the code that was determined to be most appropriate since there were 

no codes in existence describing the exact anticoagulant medication.  However, the 

anticoagulant medication codes should now be used.   

Note:  Anticoagulant medication therapy provided by a PharmD should be reported by 

using a Category III CPT code, created in 2006.  (0115T, 0116T or 0117T).   

Anticoagulant management CPT codes are relatively new and reimbursement may be 

difficult or even unobtainable from some payers.  Medicare and Medicaid do not yet cover 

these codes; however, since they are “non-covered” services, you may consider these 

services self-pay.  Working with the USPG Managed Care department would be useful to 

determine which other payers will reimburse. 

Locke, MD

-- Pratt

[Guest guest]

It probably makes monetary sense to run a coumadin clinic if you have enough patients.We have a lab in the office (run by the hospital), so we've always sent them through the lab. Locke, MD

 

We do them in the office, although we've been having issues with our machine since our nurse left (CoaguChek XS).  We bill it as a 99211 + 85610-QW + 36416.  We do not get paid for the 36416.  We get reimbursed about $28-$29 total.

 

 

 

Anyone getting paid for monitoring INR's? Not testing in the office, but monitoring over phone.

99363             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INRmeasurements) 

How much on average?

One of my past contracts - now that I look it up -- says...

99363 - $192.8199364 - $67.25 Which seem surprisingly high.

Medicare doesn't seem to cover...when I search online for pricing.

No records found. This may be due to the fact that there are no records in the system for the HCPCS code(s) selected OR one or more of the selected codes is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts.

List of HCPCS Codes

Code

Description

99363

Anticoag mgmt init

99364

Anticoag mgmt subseq

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoIbillforCoumadincheck.pdf

FAQ – How do I bill for a Coumadin check?

Scenario:  Patients on anticoagulant medication, such as Coumadin, must be monitored closely.  

These patients typically present to the office or a laboratory for a blood draw for purposes of 

running a Prothrombin test.  This test may be done by the office or the lab.  

Coding:  When these patients present to the office for this prescheduled lab draw, in the absence 

of problematic signs/symptoms that warrant evaluation of a provider (MD, ARNP, PA), ONLY the 

lab draw and Prothrombin test (if performed in the office) may be billed.  It is not appropriate to 

also bill a 99211 E/M service in this scenario*.  However, there are now CPT codes available for 

reporting the management of the anticoagulant therapy: 

99363             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; initial 90 days 

of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; each 

subsequent 90 days of therapy (must include a minimum of 3 INR

measurements) 

These codes are only to be used in the outpatient setting and not to be reported if less than 60 

continuous outpatient days of therapy management have occurred.  These codes also do not 

require the face-to-face evaluation by a provider.  Therefore, the nurse may perform the blood 

draw, the test can be run and the communication of the results/dosage changes can be done by 

the nurse as well provided the billing provider documents their involvement with review of 

results and their management plan/changes.  The bill for the anticoagulant management 

should be submitted after the 90 day period and minimum INR measurements met using the 

provider number for the provider who has performed the majority of the management during the 

90 day period. 

*It is recognized that historically Coumadin services have been billed with CPT code 

99211.  This was the code that was determined to be most appropriate since there were 

no codes in existence describing the exact anticoagulant medication.  However, the 

anticoagulant medication codes should now be used.   

Note:  Anticoagulant medication therapy provided by a PharmD should be reported by 

using a Category III CPT code, created in 2006.  (0115T, 0116T or 0117T).   

Anticoagulant management CPT codes are relatively new and reimbursement may be 

difficult or even unobtainable from some payers.  Medicare and Medicaid do not yet cover 

these codes; however, since they are “non-covered” services, you may consider these 

services self-pay.  Working with the USPG Managed Care department would be useful to 

determine which other payers will reimburse. 

Locke, MD

-- Pratt

[Guest guest]

Yes, that is what I am talking about.thanks

 

i used to do it how karen does when we were using the coag check machine in the officeif i'm not mistaken, kelly, you're talking about sending someone to the lab, making adjustments by phone/email and the billing insurance for that.  never have tried that but would definitely be interested if someone has done that and gotten paid

[Guest guest]

We were spending so much time tracking down patients and trying to manage what dose they were on, that we decided that even if we didn't make $ on going them in-house, we were providing better care to the patients to manage it ourselves.

 

It probably makes monetary sense to run a coumadin clinic if you have enough patients. We have a lab in the office (run by the hospital), so we've always sent them through the lab.

Locke, MD

 

We do them in the office, although we've been having issues with our machine since our nurse left (CoaguChek XS).  We bill it as a 99211 + 85610-QW + 36416.  We do not get paid for the 36416.  We get reimbursed about $28-$29 total.

 

 

 

Anyone getting paid for monitoring INR's?

Not testing in the office, but monitoring over phone.

99363             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of INR testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INRmeasurements) 

How much on average?

One of my past contracts - now that I look it up -- says...

99363 - $192.8199364 - $67.25 Which seem surprisingly high.

Medicare doesn't seem to cover...when I search online for pricing.

No records found. This may be due to the fact that there are no records in the system for the HCPCS code(s) selected OR one or more of the selected codes is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts.

List of HCPCS Codes

Code

Description

99363

Anticoag mgmt init

99364

Anticoag mgmt subseq

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoIbillforCoumadincheck.pdf

FAQ – How do I bill for a Coumadin check?

Scenario:  Patients on anticoagulant medication, such as Coumadin, must be monitored closely.  

These patients typically present to the office or a laboratory for a blood draw for purposes of 

running a Prothrombin test.  This test may be done by the office or the lab.  

Coding:  When these patients present to the office for this prescheduled lab draw, in the absence 

of problematic signs/symptoms that warrant evaluation of a provider (MD, ARNP, PA), ONLY the 

lab draw and Prothrombin test (if performed in the office) may be billed.  It is not appropriate to 

also bill a 99211 E/M service in this scenario*.  However, there are now CPT codes available for 

reporting the management of the anticoagulant therapy: 

99363             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; initial 90 days 

of therapy (must include a minimum of 8 INR measurements) 

99364             Anticoagulant management for an outpatient taking warfarin, physician 

review and interpretation of INR testing, patient instructions, dosage 

adjustment (as needed), and ordering of additional tests; each 

subsequent 90 days of therapy (must include a minimum of 3 INR

measurements) 

These codes are only to be used in the outpatient setting and not to be reported if less than 60 

continuous outpatient days of therapy management have occurred.  These codes also do not 

require the face-to-face evaluation by a provider.  Therefore, the nurse may perform the blood 

draw, the test can be run and the communication of the results/dosage changes can be done by 

the nurse as well provided the billing provider documents their involvement with review of 

results and their management plan/changes.  The bill for the anticoagulant management 

should be submitted after the 90 day period and minimum INR measurements met using the 

provider number for the provider who has performed the majority of the management during the 

90 day period. 

*It is recognized that historically Coumadin services have been billed with CPT code 

99211.  This was the code that was determined to be most appropriate since there were 

no codes in existence describing the exact anticoagulant medication.  However, the 

anticoagulant medication codes should now be used.   

Note:  Anticoagulant medication therapy provided by a PharmD should be reported by 

using a Category III CPT code, created in 2006.  (0115T, 0116T or 0117T).   

Anticoagulant management CPT codes are relatively new and reimbursement may be 

difficult or even unobtainable from some payers.  Medicare and Medicaid do not yet cover 

these codes; however, since they are “non-covered” services, you may consider these 

services self-pay.  Working with the USPG Managed Care department would be useful to 

determine which other payers will reimburse. 

Locke, MD

-- Pratt

-- Pratt

[Guest guest]

do you realize that if an e/m is billed, patient pays the office visit copay

each time?

grace

> >>

> >>> **

> >>>

> >>>

> >>> Anyone getting paid for monitoring INR's?

> >>> Not testing in the office, but monitoring over phone.

> >>>

> >>> 99363 Anticoagulant management for an outpatient taking

> >>> warfarin, physician review and interpretation of INR testing, patient

> >>> instructions, dosage adjustment (as needed), and ordering of additional

> >>> tests; initial 90 days of therapy (must include a minimum of 8 INR

> >>> measurements)

> >>>

> >>> 99364 Anticoagulant management for an outpatient taking

> >>> warfarin, physician review and interpretation of INR testing, patient

> >>> instructions, dosage adjustment (as needed), and ordering of additional

> >>> tests; each subsequent 90 days of therapy (must include a minimum of 3

> >>> INRmeasurements)

> >>>

> >>> How much on average?

> >>>

> >>> One of my past contracts - now that I look it up -- says...

> >>> 99363 - $192.81

> >>> 99364 - $67.25

> >>>

> >>> Which seem surprisingly high.

> >>>

> >>> Medicare doesn't seem to cover...when I search online for pricing.

> >>>

> >>> *No records found. This may be due to the fact that there are no records

> >>> in the system for the HCPCS code(s) selected OR one or more of the

selected

> >>> codes is contractor priced under the Physician Fee Schedule. Please

contact

> >>> your local Medicare Contractor for payment amounts.*

> >>>

> >>> List of HCPCS Codes

> >>> Code Description 99363 Anticoag mgmt init 99364 Anticoag mgmt subseq

> >>>

> >>>

> >>>

> >>>

> >>>

> >>>

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoI\

billforCoumadincheck.pdf

> >>>

> >>> FAQ – How do I bill for a Coumadin check?

> >>> Scenario: Patients on anticoagulant medication, such as Coumadin, must

> >>> be monitored closely.

> >>> These patients typically present to the office or a laboratory for a

> >>> blood draw for purposes of

> >>> running a Prothrombin test. This test may be done by the office or the

> >>> lab.

> >>> Coding: When these patients present to the office for this prescheduled

> >>> lab draw, in the absence

> >>> of problematic signs/symptoms that warrant evaluation of a provider (MD,

> >>> ARNP, PA), ONLY the

> >>> lab draw and Prothrombin test (if performed in the office) may be billed.

> >>> It is not appropriate to

> >>> also bill a 99211 E/M service in this scenario*. However, there are now

> >>> CPT codes available for

> >>> reporting the management of the anticoagulant therapy:

> >>> 99363 Anticoagulant management for an outpatient taking

> >>> warfarin, physician

> >>> review and interpretation of INR testing, patient instructions, dosage

> >>> adjustment (as needed), and ordering of additional tests; initial 90

> >>> days

> >>> of therapy (must include a minimum of 8 INR measurements)

> >>> 99364 Anticoagulant management for an outpatient taking

> >>> warfarin, physician

> >>> review and interpretation of INR testing, patient instructions, dosage

> >>> adjustment (as needed), and ordering of additional tests; each

> >>> subsequent 90 days of therapy (must include a minimum of 3 INR

> >>> measurements)

> >>> These codes are only to be used in the outpatient setting and not to be

> >>> reported if less than 60

> >>> continuous outpatient days of therapy management have occurred. These

> >>> codes also do not

> >>> require the face-to-face evaluation by a provider. Therefore, the nurse

> >>> may perform the blood

> >>> draw, the test can be run and the communication of the results/dosage

> >>> changes can be done by

> >>> the nurse as well provided the billing provider documents their

> >>> involvement with review of

> >>> results and their management plan/changes. The bill for the

> >>> anticoagulant management

> >>> should be submitted after the 90 day period and minimum INR measurements

> >>> met using the

> >>> provider number for the provider who has performed the majority of the

> >>> management during the

> >>> 90 day period.

> >>> *It is recognized that historically Coumadin services have been billed

> >>> with CPT code

> >>> 99211. This was the code that was determined to be most appropriate

> >>> since there were

> >>> no codes in existence describing the exact anticoagulant medication.

> >>> However, the

> >>> anticoagulant medication codes should now be used.

> >>> Note: Anticoagulant medication therapy provided by a PharmD should be

> >>> reported by

> >>> using a Category III CPT code, created in 2006. (0115T, 0116T or 0117T).

> >>>

> >>> Anticoagulant management CPT codes are relatively new and reimbursement

> >>> may be

> >>> difficult or even unobtainable from some payers. Medicare and Medicaid

> >>> do not yet cover

> >>> these codes; however, since they are " non-covered " services, you may

> >>> consider these

> >>> services self-pay. Working with the USPG Managed Care department would

> >>> be useful to

> >>> determine which other payers will reimburse.

> >>>

> >>> Locke, MD

> >>>

> >>>

> >>

> >>

> >> --

> >> * Pratt*

> >>

> >>

> >

> >

>

>

>

> --

> * Pratt*

>

[Guest guest]

karen,

can you do that? just taking the allowed amount and not the copays too? i

thought you cant.

g

> >

> >

> > > >>

> > > >>> **

> > > >>>

> > > >>>

> > > >>> Anyone getting paid for monitoring INR's?

> > > >>> Not testing in the office, but monitoring over phone.

> > > >>>

> > > >>> 99363 Anticoagulant management for an outpatient taking

> > > >>> warfarin, physician review and interpretation of INR testing, patient

> > > >>> instructions, dosage adjustment (as needed), and ordering of

> > additional

> > > >>> tests; initial 90 days of therapy (must include a minimum of 8 INR

> > > >>> measurements)

> > > >>>

> > > >>> 99364 Anticoagulant management for an outpatient taking

> > > >>> warfarin, physician review and interpretation of INR testing, patient

> > > >>> instructions, dosage adjustment (as needed), and ordering of

> > additional

> > > >>> tests; each subsequent 90 days of therapy (must include a minimum of

> > 3

> > > >>> INRmeasurements)

> > > >>>

> > > >>> How much on average?

> > > >>>

> > > >>> One of my past contracts - now that I look it up -- says...

> > > >>> 99363 - $192.81

> > > >>> 99364 - $67.25

> > > >>>

> > > >>> Which seem surprisingly high.

> > > >>>

> > > >>> Medicare doesn't seem to cover...when I search online for pricing.

> > > >>>

> > > >>> *No records found. This may be due to the fact that there are no

> > records

> > > >>> in the system for the HCPCS code(s) selected OR one or more of the

> > selected

> > > >>> codes is contractor priced under the Physician Fee Schedule. Please

> > contact

> > > >>> your local Medicare Contractor for payment amounts.*

> > > >>>

> > > >>> List of HCPCS Codes

> > > >>> Code Description 99363 Anticoag mgmt init 99364 Anticoag mgmt subseq

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> > > >>>

> >

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoI\

billforCoumadincheck.pdf

> > > >>>

> > > >>> FAQ – How do I bill for a Coumadin check?

> > > >>> Scenario: Patients on anticoagulant medication, such as Coumadin,

> > must

> > > >>> be monitored closely.

> > > >>> These patients typically present to the office or a laboratory for a

> > > >>> blood draw for purposes of

> > > >>> running a Prothrombin test. This test may be done by the office or

> > the

> > > >>> lab.

> > > >>> Coding: When these patients present to the office for this

> > prescheduled

> > > >>> lab draw, in the absence

> > > >>> of problematic signs/symptoms that warrant evaluation of a provider

> > (MD,

> > > >>> ARNP, PA), ONLY the

> > > >>> lab draw and Prothrombin test (if performed in the office) may be

> > billed.

> > > >>> It is not appropriate to

> > > >>> also bill a 99211 E/M service in this scenario*. However, there are

> > now

> > > >>> CPT codes available for

> > > >>> reporting the management of the anticoagulant therapy:

> > > >>> 99363 Anticoagulant management for an outpatient taking

> > > >>> warfarin, physician

> > > >>> review and interpretation of INR testing, patient instructions,

> > dosage

> > > >>> adjustment (as needed), and ordering of additional tests; initial 90

> > > >>> days

> > > >>> of therapy (must include a minimum of 8 INR measurements)

> > > >>> 99364 Anticoagulant management for an outpatient taking

> > > >>> warfarin, physician

> > > >>> review and interpretation of INR testing, patient instructions,

> > dosage

> > > >>> adjustment (as needed), and ordering of additional tests; each

> > > >>> subsequent 90 days of therapy (must include a minimum of 3 INR

> > > >>> measurements)

> > > >>> These codes are only to be used in the outpatient setting and not to

> > be

> > > >>> reported if less than 60

> > > >>> continuous outpatient days of therapy management have occurred. These

> > > >>> codes also do not

> > > >>> require the face-to-face evaluation by a provider. Therefore, the

> > nurse

> > > >>> may perform the blood

> > > >>> draw, the test can be run and the communication of the results/dosage

> > > >>> changes can be done by

> > > >>> the nurse as well provided the billing provider documents their

> > > >>> involvement with review of

> > > >>> results and their management plan/changes. The bill for the

> > > >>> anticoagulant management

> > > >>> should be submitted after the 90 day period and minimum INR

> > measurements

> > > >>> met using the

> > > >>> provider number for the provider who has performed the majority of

> > the

> > > >>> management during the

> > > >>> 90 day period.

> > > >>> *It is recognized that historically Coumadin services have been

> > billed

> > > >>> with CPT code

> > > >>> 99211. This was the code that was determined to be most appropriate

> > > >>> since there were

> > > >>> no codes in existence describing the exact anticoagulant medication.

> > > >>> However, the

> > > >>> anticoagulant medication codes should now be used.

> > > >>> Note: Anticoagulant medication therapy provided by a PharmD should be

> > > >>> reported by

> > > >>> using a Category III CPT code, created in 2006. (0115T, 0116T or

> > 0117T).

> > > >>>

> > > >>> Anticoagulant management CPT codes are relatively new and

> > reimbursement

> > > >>> may be

> > > >>> difficult or even unobtainable from some payers. Medicare and

> > Medicaid

> > > >>> do not yet cover

> > > >>> these codes; however, since they are " non-covered " services, you may

> > > >>> consider these

> > > >>> services self-pay. Working with the USPG Managed Care department

> > would

> > > >>> be useful to

> > > >>> determine which other payers will reimburse.

> > > >>>

> > > >>> Locke, MD

> > > >>>

> > > >>>

> > > >>

> > > >>

> > > >> --

> > > >> * Pratt*

> > > >>

> > > >>

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > > * Pratt*

> > >

> >

> >

> >

>

>

>

> --

> * Pratt*

>

[Guest guest]

Paid or not, phone management of coumadin was a pain in the neck with

many after hours phone calls and phone tag.

We don't have a RN (can't afford them here) so we see the patient for a

physician or PA appt with a 99212 or more as the charge. Most patients

have many other active chronic problems that need attention and

frequently patients add a few " while I'm here can you look at... "

problems so a 99214 is the most common charge.

A couple of patients left because of the copay issue but most are very

happy to get several problems taken care of at one visit.

Changing from managing coumadin over the phone to in the office was one

of the better improvements we've made.

> We were spending so much time tracking down patients and trying to manage

> what dose they were on, that we decided that even if we didn't make $ on

> going them in-house, we were providing better care to the patients to manage

> it ourselves.

>

> On Mon, Aug 1, 2011 at 1:11 PM, Locke wrote:

>

>> **

>>

>>

>> It probably makes monetary sense to run a coumadin clinic if you have

>> enough patients.

>> We have a lab in the office (run by the hospital), so we've always sent

>> them through the lab.

>>

>> Locke, MD

>>

>>

>>

>

>

[Guest guest]

how about medicare?

> > >

> > >

> > > > >>

> > > > >>> **

> > > > >>>

> > > > >>>

> > > > >>> Anyone getting paid for monitoring INR's?

> > > > >>> Not testing in the office, but monitoring over phone.

> > > > >>>

> > > > >>> 99363 Anticoagulant management for an outpatient taking

> > > > >>> warfarin, physician review and interpretation of INR testing,

> patient

> > > > >>> instructions, dosage adjustment (as needed), and ordering of

> > > additional

> > > > >>> tests; initial 90 days of therapy (must include a minimum of 8 INR

> > > > >>> measurements)

> > > > >>>

> > > > >>> 99364 Anticoagulant management for an outpatient taking

> > > > >>> warfarin, physician review and interpretation of INR testing,

> patient

> > > > >>> instructions, dosage adjustment (as needed), and ordering of

> > > additional

> > > > >>> tests; each subsequent 90 days of therapy (must include a minimum

> of

> > > 3

> > > > >>> INRmeasurements)

> > > > >>>

> > > > >>> How much on average?

> > > > >>>

> > > > >>> One of my past contracts - now that I look it up -- says...

> > > > >>> 99363 - $192.81

> > > > >>> 99364 - $67.25

> > > > >>>

> > > > >>> Which seem surprisingly high.

> > > > >>>

> > > > >>> Medicare doesn't seem to cover...when I search online for pricing.

> > > > >>>

> > > > >>> *No records found. This may be due to the fact that there are no

> > > records

> > > > >>> in the system for the HCPCS code(s) selected OR one or more of the

> > > selected

> > > > >>> codes is contractor priced under the Physician Fee Schedule.

> Please

> > > contact

> > > > >>> your local Medicare Contractor for payment amounts.*

> > > > >>>

> > > > >>> List of HCPCS Codes

> > > > >>> Code Description 99363 Anticoag mgmt init 99364 Anticoag mgmt

> subseq

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > > > >>>

> > >

>

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoI\

billforCoumadincheck.pdf

> > > > >>>

> > > > >>> FAQ – How do I bill for a Coumadin check?

> > > > >>> Scenario: Patients on anticoagulant medication, such as Coumadin,

> > > must

> > > > >>> be monitored closely.

> > > > >>> These patients typically present to the office or a laboratory for

> a

> > > > >>> blood draw for purposes of

> > > > >>> running a Prothrombin test. This test may be done by the office or

> > > the

> > > > >>> lab.

> > > > >>> Coding: When these patients present to the office for this

> > > prescheduled

> > > > >>> lab draw, in the absence

> > > > >>> of problematic signs/symptoms that warrant evaluation of a

> provider

> > > (MD,

> > > > >>> ARNP, PA), ONLY the

> > > > >>> lab draw and Prothrombin test (if performed in the office) may be

> > > billed.

> > > > >>> It is not appropriate to

> > > > >>> also bill a 99211 E/M service in this scenario*. However, there

> are

> > > now

> > > > >>> CPT codes available for

> > > > >>> reporting the management of the anticoagulant therapy:

> > > > >>> 99363 Anticoagulant management for an outpatient taking

> > > > >>> warfarin, physician

> > > > >>> review and interpretation of INR testing, patient instructions,

> > > dosage

> > > > >>> adjustment (as needed), and ordering of additional tests; initial

> 90

> > > > >>> days

> > > > >>> of therapy (must include a minimum of 8 INR measurements)

> > > > >>> 99364 Anticoagulant management for an outpatient taking

> > > > >>> warfarin, physician

> > > > >>> review and interpretation of INR testing, patient instructions,

> > > dosage

> > > > >>> adjustment (as needed), and ordering of additional tests; each

> > > > >>> subsequent 90 days of therapy (must include a minimum of 3 INR

> > > > >>> measurements)

> > > > >>> These codes are only to be used in the outpatient setting and not

> to

> > > be

> > > > >>> reported if less than 60

> > > > >>> continuous outpatient days of therapy management have occurred.

> These

> > > > >>> codes also do not

> > > > >>> require the face-to-face evaluation by a provider. Therefore, the

> > > nurse

> > > > >>> may perform the blood

> > > > >>> draw, the test can be run and the communication of the

> results/dosage

> > > > >>> changes can be done by

> > > > >>> the nurse as well provided the billing provider documents their

> > > > >>> involvement with review of

> > > > >>> results and their management plan/changes. The bill for the

> > > > >>> anticoagulant management

> > > > >>> should be submitted after the 90 day period and minimum INR

> > > measurements

> > > > >>> met using the

> > > > >>> provider number for the provider who has performed the majority of

> > > the

> > > > >>> management during the

> > > > >>> 90 day period.

> > > > >>> *It is recognized that historically Coumadin services have been

> > > billed

> > > > >>> with CPT code

> > > > >>> 99211. This was the code that was determined to be most

> appropriate

> > > > >>> since there were

> > > > >>> no codes in existence describing the exact anticoagulant

> medication.

> > > > >>> However, the

> > > > >>> anticoagulant medication codes should now be used.

> > > > >>> Note: Anticoagulant medication therapy provided by a PharmD should

> be

> > > > >>> reported by

> > > > >>> using a Category III CPT code, created in 2006. (0115T, 0116T or

> > > 0117T).

> > > > >>>

> > > > >>> Anticoagulant management CPT codes are relatively new and

> > > reimbursement

> > > > >>> may be

> > > > >>> difficult or even unobtainable from some payers. Medicare and

> > > Medicaid

> > > > >>> do not yet cover

> > > > >>> these codes; however, since they are " non-covered " services, you

> may

> > > > >>> consider these

> > > > >>> services self-pay. Working with the USPG Managed Care department

> > > would

> > > > >>> be useful to

> > > > >>> determine which other payers will reimburse.

> > > > >>>

> > > > >>> Locke, MD

> > > > >>>

> > > > >>>

> > > > >>

> > > > >>

> > > > >> --

> > > > >> * Pratt*

> > > > >>

> > > > >>

> > > > >

> > > > >

> > > >

> > > >

> > > >

> > > > --

> > > > * Pratt*

> > > >

> > >

> > >

> > >

> >

> >

> >

> > --

> > * Pratt*

> >

>

[Guest guest]

I echo 's comments. Usually a 99212 and if a BTW emerges, it becomes a 99213 or 99214.

One insurer reimburses for 3 months of management of coumadin done at lab. Other patients pay $60 every three months as "uncovered" service. Agree with having cardiologist manage it if patients balk at paying us copays or 3 month management fee.

[Guest guest]

I was the director of the Anticoagulation Clinic at OHSU a no. of yrs

ago. It's not a money generating operation but a cost savings in the

long run, ie keeps people out of the hospital by decr bleeds and

under-treatment.The clinic was bounced around...eventually was taken

back by cardiol who probably had the most pts going there. Data shows

that these clinics do the best job in managing INRs--that's all they do.

Not worthwhile for a small no. of pts.

Ellen son, MD

Portland, OR

>

> It probably makes monetary sense to run a coumadin clinic if you have

> enough patients.

>

> We have a lab in the office (run by the hospital), so we've always

> sent them through the lab.

>

> Locke, MD

>

> On Mon, Aug 1, 2011 at 12:52 PM, Pratt <kpratt.1022@...

> > wrote:

>

> We do them in the office, although we've been having issues with

> our machine since our nurse left (CoaguChek XS). We bill it as a

> 99211 + 85610-QW + 36416. We do not get paid for the 36416. We get

> reimbursed about $28-$29 total.

>

> On Mon, Aug 1, 2011 at 11:05 AM, Locke

> > wrote:

>

> Anyone getting paid for monitoring INR's?

>

> Not testing in the office, but monitoring over phone.

>

> 99363 Anticoagulant management for an outpatient taking

> warfarin, physician review and interpretation of INR testing,

> patient instructions, dosage adjustment (as needed), and

> ordering of additional tests; initial 90 days of therapy (must

> include a minimum of 8 INR measurements)

>

> 99364 Anticoagulant management for an outpatient taking

> warfarin, physician review and interpretation of INR testing,

> patient instructions, dosage adjustment (as needed), and

> ordering of additional tests; each subsequent 90 days of

> therapy (must include a minimum of 3 INRmeasurements)

>

> How much on average?

>

> One of my past contracts - now that I look it up -- says...

> 99363 - $192.81

> 99364 - $67.25

>

> Which seem surprisingly high.

>

>

> Medicare doesn't seem to cover...when I search online for pricing.

>

> *No records found. This may be due to the fact that there are

> no records in the system for the HCPCS code(s) selected OR one

> or more of the selected codes is contractor priced under the

> Physician Fee Schedule. Please contact your local Medicare

> Contractor for payment amounts.*

>

>

> List of HCPCS Codes

>

> Code Description

> 99363 Anticoag mgmt init

> 99364 Anticoag mgmt subseq

>

>

>

>

>

http://health.usf.edu/NR/rdonlyres/267173D3-234D-484C-AA3B-36CA6C216644/0/HowdoI\

billforCoumadincheck.pdf

>

> FAQ – How do I bill for a Coumadin check?

> Scenario: Patients on anticoagulant medication, such as

> Coumadin, must be monitored closely.

> These patients typically present to the office or a laboratory

> for a blood draw for purposes of

> running a Prothrombin test. This test may be done by the

> office or the lab.

> Coding: When these patients present to the office for this

> prescheduled lab draw, in the absence

> of problematic signs/symptoms that warrant evaluation of a

> provider (MD, ARNP, PA), ONLY the

> lab draw and Prothrombin test (if performed in the office) may

> be billed. It is not appropriate to

> also bill a 99211 E/M service in this scenario*. However,

> there are now CPT codes available for

> reporting the management of the anticoagulant therapy:

> 99363 Anticoagulant management for an outpatient taking

> warfarin, physician

> review and interpretation of INR testing, patient

> instructions, dosage

> adjustment (as needed), and ordering of additional tests;

> initial 90 days

> of therapy (must include a minimum of 8 INR measurements)

> 99364 Anticoagulant management for an outpatient taking

> warfarin, physician

> review and interpretation of INR testing, patient

> instructions, dosage

> adjustment (as needed), and ordering of additional tests; each

> subsequent 90 days of therapy (must include a minimum of 3 INR

> measurements)

> These codes are only to be used in the outpatient setting and

> not to be reported if less than 60

> continuous outpatient days of therapy management have

> occurred. These codes also do not

> require the face-to-face evaluation by a provider. Therefore,

> the nurse may perform the blood

> draw, the test can be run and the communication of the

> results/dosage changes can be done by

> the nurse as well provided the billing provider documents

> their involvement with review of

> results and their management plan/changes. The bill for the

> anticoagulant management

> should be submitted after the 90 day period and minimum INR

> measurements met using the

> provider number for the provider who has performed the

> majority of the management during the

> 90 day period.

> *It is recognized that historically Coumadin services have

> been billed with CPT code

> 99211. This was the code that was determined to be most

> appropriate since there were

> no codes in existence describing the exact anticoagulant

> medication. However, the

> anticoagulant medication codes should now be used.

> Note: Anticoagulant medication therapy provided by a PharmD

> should be reported by

> using a Category III CPT code, created in 2006. (0115T, 0116T

> or 0117T).

> Anticoagulant management CPT codes are relatively new and

> reimbursement may be

> difficult or even unobtainable from some payers. Medicare and

> Medicaid do not yet cover

> these codes; however, since they are “non-covered” services,

> you may consider these

> services self-pay. Working with the USPG Managed Care

> department would be useful to

> determine which other payers will reimburse.

>

> Locke, MD

>

>

>

>

> --

> / Pratt/

>

>

>

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