Cardiology Coding Alert

Question: If my cardiologist performs a finger-stick Coumadin test, is it OK to report a low-level E/M, such as 99211, in addition to the test?

Wyoming Subscriber

Answer: As long as your nurse did not simply perform the test and she has clearly documented the 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. Of course, this is assuming your cardiologist documents medical necessity for this history and physical examination.

Cardiology practices frequently report 99211 in addition to 85610 because patients who come in for Coumadin monitoring can have co-existing conditions or 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.