Cardiology Coding Alert

Question: My cardiologist performed a finger-stick Coumadin test. Can I report a low-level E/M, such as 99211?

Missouri Subscriber
 
Answer: As long as your cardiologist did not a simply perform the test and he has clearly documented medical necessity for an E/M visit, you may use 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) in addition to 85610 (Prothrombin time) with modifier -QW (CLIA-waived test).

For example, if the nurse takes the patient's vital signs, checks for bruises, discusses medication compliance, gives dietary instruction, and then documents these services, you can use 99211.

Cardiology practices report 99211 in addition to 85610 frequently, because patients who come in for Coumadin monitoring can have co-existing conditions and complications that arise from time to time.

However, routine separate billing of E/M services for this group of patients is not indicated or appropriate.