# In office INR



## kmaddocks19 (Nov 5, 2014)

I have a question we are a family practice and we just got the new machine to check patients INR in the office and i was wondering if anyone knows the correct CPT code to bill for this the only one i can find is 85610 and I think this is for the lab not the office. Thanks in advance.
kara


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## Amy Pritchett (Nov 5, 2014)

In this case, CMS states to use the 99211 (Nurse's Visit) code for the draw of the coumadin level. Then you would list the primary diagnosis code as V58.61 (long-term use of anticoagulants and then the primary reason for the use of the anticoagulant (i.e. atrial fibrillation, blood clots) as the secondary diagnosis code. The lab can bill an 85610-QW that will be paid to the physician as long as the physician has a CLIA waiver on file.

I hope this helps you


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## mitchellde (Nov 5, 2014)

Amy Pritchett said:


> In this case, CMS states to use the 99211 (Nurse's Visit) code for the draw of the coumadin level. Then you would list the primary diagnosis code as V58.61 (long-term use of anticoagulants and then the primary reason for the use of the anticoagulant (i.e. atrial fibrillation, blood clots) as the secondary diagnosis code. The lab can bill an 85610-QW that will be paid to the physician as long as the physician has a CLIA waiver on file.
> 
> I hope this helps you



Where does CMS state to code a lab draw as a 99211?  I ask because I have found the exact opposite at CMS where they state you never use a 99211 for a blood draw, you use the 36415 for the veinipuncture.  The codes for a lab check due to drugs according to the AHA coding clinics is V58.83 first listed (Z51.81) and the V58.61 secondary ( it is secondary only allowed) (Z79.01).


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## cmontgomery (Nov 14, 2014)

We're having issues with this one.  We are billing out 99211-25 with primary dx of say 427.61 then 85610-QW and 36415-59 with the v58.61.  Novitas is the one that states to add mod 25 to the 99211.  We used to just bill a 99211, 85610-qw and 36415-59 with v58.61 with no problems but this just recently changed.


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## mallorywilsonx3@gmail.com (Dec 29, 2014)

We are having issues with this as well. Only recently. Did something change? 

We have always built Primary Dx. V58.61 with 99211 and 85610. Now Medicare does not want to pay for the 99211 and even our Clearinghouse is rejecting them. 

Has something changed with this?


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## Saedron (Jan 4, 2015)

cmontgomery said:


> We're having issues with this one.  We are billing out 99211-25 with primary dx of say 427.61 then 85610-QW and 36415-59 with the v58.61.  Novitas is the one that states to add mod 25 to the 99211.  We used to just bill a 99211, 85610-qw and 36415-59 with v58.61 with no problems but this just recently changed.




I can't imagine a carrier wanting a 25 on a level one visit, especially one where there is no procedure the same day, just labs. I'd look into that because most of the carriers I deal with do not consider a level one visit 'significant' enough to warrant a 25 modifier.

Also, CMS has a status code B on 36416 (fingerstick) so it's not separately payable.

I code my INRs with 85610QW and V58.83,v58.61 and send it out. If there is a presenting problem that supports medical necessity for an E/M then I will look at it, but most times the patient shows up to the lab, gets the draw, and leaves.


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## mitchellde (Jan 4, 2015)

Saedron said:


> I can't imagine a carrier wanting a 25 on a level one visit, especially one where there is no procedure the same day, just labs. I'd look into that because most of the carriers I deal with do not consider a level one visit 'significant' enough to warrant a 25 modifier.
> 
> Also, CMS has a status code B on 36416 (fingerstick) so it's not separately payable.
> 
> I code my INRs with 85610QW and V58.83,v58.61 and send it out. If there is a presenting problem that supports medical necessity for an E/M then I will look at it, but most times the patient shows up to the lab, gets the draw, and leaves.



This is the correct way to code INR encounters.  CMS does not say to bill these as a 99211.  They state that it is incorrect to use a 99211 for a blood collection encounter.  There would be no 25 modifier and the documentation could not support it if the patient were there just for the lab.  CMS does state to use the 99211 if this is a Coumadin clinic, and they have specific items that must be covered with the patient and documented in the note, but then you do not bill the lab charges also just the 99211, the requirements for this is much more than a typical lab encounter.


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## LeaHarris (Jan 9, 2015)

So are you getting paid by coding 85610QW and V58.83,v58.61 if the patient comes to a family practice for a Protime finger stick and nothing else?


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## Skenyon (Feb 4, 2015)

*Office INR Billing*

I think people are confusing blood draw/lab specimum sent out  vs  finger prick with lancet and a device that is used in office that gives real time results. In our office we use a device, get the result, consult the physician,and direct patient on his/her dosing of coumadin before they leave the office. We code 99211, 86510-QW, V58.61.


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## mitchellde (Feb 4, 2015)

The finger stick is coded with a 36416.


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