Cardiology Coding Alert

If you're not up to speed on two crucial aspects of Coumadin monitoring in-office finger stick coding and medical necessity to support billing 99211 you could be losing pay your practice deserves. Cardiology practices use the blood thinner Coumadin, or warfarin sodium, to prevent clots in the heart and the vascular system, and complications from other disorders, such as atrial fibrillation. Clinical staff must carefully monitor patients taking Coumadin because too much Coumadin can lead to serious, even fatal bleeding.

Mechanical-valve patients require even more intensive monitoring because they take 2.5 to 3.5 times more Coumadin than other patients do, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C., and compliance manager for Mid Carolina Cardiology in Charlotte, N.C. Until recently, physicians monitored a Coumadin patient by regularly sending a blood sample to an outside laboratory for a prothrombin time (Protime) test to determine the international normalized ratio (INR), or how long it takes the blood to clot. But now, devices are available that measure blood clotting speed with a sample taken from a simple finger stick. Many practices use these devices to check their patients'levels in the office, giving the cardiologist almost instant results and making it possible to adjust medication on the spot. Beginning in 2003, cardiology practices will be able to monitor mechanical heart valve patients on Coumadin from home, Collins says. (For coding instructions on in-home Coumadin monitoring, see next month's Cardiology Coding Alert.) Don't Get Stuck With Old Codes If you're wondering how to correctly code Coumadin monitoring with in-office devices, taking a look at the following four questions and answers will fill in knowledge gaps. Can I use G0001 or 36416 for the finger stick? If the patient is on Medicare, like most Coumadin patients, the answer is no. Medicare will not pay for a heel, ear or finger stick. HCPCS code G0001 (Routine venipuncture for collection of specimen[s]) is specifically for venipuncture, or blood samples taken via needle from a vein. (Use G0001 only if your office still takes blood samples from a vein and sends the patient's blood to an outside laboratory for Coumadin-level analysis.) If the patient having the in-office Protime test is covered by private insurance, you may be able to bill 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for the finger stick. Check with the carrier for more information. How should I code the in-office, finger-stick Protime lab test for a Medicare patient? Use 85610 (Prothrombin time). Most carriers also ask that you append the -QW modifier (CLIA-waived test) to indicate that CMS has included the test on a list of procedures that do not have to meet the requirements of [...]