Cardiology Coding Alert

Question: Some of the cardiologists in our office want to charge a low-level office visit when reviewing prothrombin times (PTs). Can this be done without a face-to-face visit? What are the guidelines for reviewing labs drawn outside of the office? We have quite a few patients we follow for PTs and are not sure how to get compensated for time spent.

Kansas Subscriber
Answer: In most cases Medicare will not pay for a visit unless the cardiologist (or a nonphysician practitioner) has spent face-to-face time with the patient, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. She emphasizes that discussing test results with the patient on the phone does not count.

The order/review of the PT could add to the complexity of the patients next visit, but only if the cardiologist refers to the test or to the phone discussion with the patient about the test.

Additionally, E/M code 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) should not be billed when a nurse takes a PT unless documentation shows that the nurse did more than draw blood.  Documentation could include discussing issues unique to the patients medical condition and/or counseling.Although not much documentation is needed to justify 99211, it is inappropriate to bill this code every time the nurse sees the patient for an injection.