Cardiology Coding Alert

Question: When we report a finger-stick Coumadin test, may we also report a low-level E/M, such as 99211?

Answer: The answer depends on the services performed and documented.

If a nurse simply performs the finger-stick test and does not perform a medically necessary E/M, you should report 85610 (Prothrombin time) with modifier QW (CLIA waived test).

If instead, the nurse or another provider clearly documents 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-QW.

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

But watch out: Routine separate billing of E/M services for this group of patients is not indicated or appropriate.