Cardiology Coding Alert

Question: Should cardiologists bill 99211 with Protime checks?


Tennessee Subscriber
Answer: In general, you should not code 99211 with every Protime check (also called Coumadin clinic visit). Carrier guidelines are not consistent, but most say your cardiologist's documentation needs to show an exchange of information and medical decision-making that is in excess of a "typical" Coumadin clinic visit (such as not merely a standard list of questions that your cardiologist asks of each patient plus dosage schedule adjustments). The same logic applies to patients coming into the office just for lipid profile blood draws.

For you to bill 99211, the documentation must support that staff provided a separate E/M service in excess of that typically provided to a patient just coming in for the test. You must document medical necessity, such as noting that the patient is having difficulties with the medication. Also, for Medicare (and some other payers), you must meet incident-to guidelines, which means, among other criteria, that the physician be in the office suite. Also make sure that you have the identity of the ancillary staff member providing the service recorded in the medical record. 

But keep in mind that you can bill separately for your blood draw. Use 36415 (Collection of venous blood by venipuncture). Make sure that the procedure is truly a blood draw and not a finger, heel or ear stick (36416, Collection of capillary blood specimen).

Many practices perform Protime tests on blood collected by finger, heel or ear sticks, as opposed to venipuncture. Medicare and a growing number of non-Medicare payers do not reimburse for collecting blood this way.