# pt/inr question



## ruthan (Dec 27, 2007)

I am in need of someone's point of view on this situation. I work at a facility in which we have many patient's that have standing orders for PT/INR, and Coumadin Therapy. Most generally the Drs. give us the diagnosis as to why they are on the Coumadin and getting the PT checked, so we have been coding these cases with the diagnosis given and the Long Term Med. Mtr. diags. (ie. 453.9 and V58.61). It has come to my attention that we should not be coding it in this way, but instead using the V58.83 then the V58.61 (encounter for therapuetic drug monitoring, then the long term mtr. code) is this correct? And also would it be incorrect to include the actual problem as to why there are on the meds?
I have read the Coding Clinics, 2Q2004 pg. 10-11, and Coding Clinic 3Q2002, pg. 15-16, but they do not seem to get a specific scenario. Any guidance would be much appreciated


----------



## NAKARAK2 (Jan 20, 2009)

*Pt/INR question*

Did you ever get any answers to this question.  I would like to know how we code this also.  Do we use Primary diagnosis, then V58.61, continuously for the INR therapy?  Also, can we use the 90862 Medication management code for the services?  Thank you.


----------



## rthames052006 (Jan 20, 2009)

ruthan said:


> I am in need of someone's point of view on this situation. I work at a facility in which we have many patient's that have standing orders for PT/INR, and Coumadin Therapy. Most generally the Drs. give us the diagnosis as to why they are on the Coumadin and getting the PT checked, so we have been coding these cases with the diagnosis given and the Long Term Med. Mtr. diags. (ie. 453.9 and V58.61). It has come to my attention that we should not be coding it in this way, but instead using the V58.83 then the V58.61 (encounter for therapuetic drug monitoring, then the long term mtr. code) is this correct? And also would it be incorrect to include the actual problem as to why there are on the meds?
> I have read the Coding Clinics, 2Q2004 pg. 10-11, and Coding Clinic 3Q2002, pg. 15-16, but they do not seem to get a specific scenario. Any guidance would be much appreciated



We have always coded it as such.... the reason pt is on coumadin then the 
V58.61, we have not had any issues. I hope we get some more takers on this question.


----------



## Anna Weaver (Jan 21, 2009)

*pt/inr*

I code it both ways depending: If the physician gives me a reason for the patient being on coumadin, I use this as the primary, then the V58.61, I do not use the V58.83 in this instance. If the physician says they are on coumadin therapy and does not give me a reason, then I add the V58.83 and use the V58.61 as secondary. We started doing that when we were no longer allowed to use the V58.6x codes as primary. 
Hope this helps.


----------



## dtricia (Apr 13, 2010)

*Pt/inr*

We will soon be opening a Coag Clinic and I found a question/response about the use of these codes.  It says the V58.83 is used first to indicate the Encounter for therapeutic drug monitoring, followed by the V58.61 . This could be followed by a history code such as V12.5x if documented.
I think if the condition still exists you would not use the V58.83...it is not monitoring...seems more like active therapy.
I am glad to ready your input on these scenarios!


----------



## kbarron (Jul 5, 2013)

What about a pt who has PT/INR done at the same time as a medical visit. Would you put 25 on the office visit as this really had nothing to do with the nature of visit.


----------



## Marybeth (Jul 17, 2013)

We usually code as follows:  dx (such as 424.1 or 427.31) + V58.61 and/or V58.83 - the 85610 needs to have a QW mod.  With coding this way we never have them deny.  Also, if using an E/M on the same date add a 25 mod to the E/M.  (If not see a phys and the pt was counseled ref their coumadin then  you can add a 99211 w/o the 25 mod)


----------

