# E/m on pt/inr



## hsmith67 (May 12, 2010)

OK, This ?/issue has been posted several times and several different ways with very conflicting answers and responses. 

Internal Medicine practice (no PharmD involved). Provider established a guideline of what they deem acceptable PT/INR results to continue current coumadin therapy. If phlebotomist sees results are within acceptable range, phlebotomist advises patient to stay on same regimen. If results are outside acceptable range then phlebotomist takes results to provider. Provider may or may not see patient but does make some decisions about how to adjust coumadin therapy and when to have patient come back for recheck. 

Typically, we bill venipuncture and 85610 QW only as the results are within accpetable range (no E/M billed). When not acceptable range results, physician is brought the results and physician will either: a) advise phlebotomist how to instruct patient to modify coumadin regimen or if results really off b) go see patient in lab and discuss diet/bruising, etc. and advise patient how to modify coumadin regimen. In this scenario (a AND b) we bill 99212, 85610 QW, and venipuncture. 

Office manager thinks we should bill 99211 and physician thinks we should bill 99212 as I've always heard 99211=nurse/non-provider and 99212 and greater = provider involved.

Please help me settle this dispute and be as specific as possible with specific guidelines I can show to my provider and office manager vs. simply an opinion because that's how you do it or think it should be done.

Thanks very much!


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## mitchellde (May 12, 2010)

you cannot bill a 99211 at all, you may not bill a 99212 unless the physician sees the patient face to face and documents the elements necessary for a 99212 per the 95/97 guidelines.  A 99212 may not used for non practioners.


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## MnTwins29 (May 13, 2010)

*Time-based?*

In scenario B, where the physician is advising the patient, what about using time-based coding?  From that description, it is entirely counseling - if he spent at least 10 minutes with the patient, 5 of it counseling, and DOCUMENTED as such, 99212 would be justified.


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