Cardiology Coding Alert

Question: I'm finding that Medicare is not accepting the new codes for Coumadin (warfarin). My Noridian Medicare representative confirmed that for me, but should I use the new codes 99363-99364 with other carriers? Or should I continue on as usual and disregard all the information about this? Is anyone paying for it?

Washington Subscriber

Answer: First, Medicare does not cover these codes, but that doesn't mean other payers won't. But you have to be careful how you submit them.

If you're submitting 99363-99364 to non-Medicare carriers, you should keep in mind that these new codes were not effective until Jan. 1, 2007. Because their code descriptors describe 60-90 days of service, you cannot report these codes until 60-90 days after Jan. 1.
 
Another issue to keep in mind is that you cannot use 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio [INR] testing, patient instructions, dosage adjustment [as needed], and ordering of additional tests; initial 90 days of therapy [must include a minimum of 8 INR measurements]) and 99364 ( each subsequent 90 days of therapy [must include a minimum of 3 INR measurements]) for nurse Coumadin clinics. CPT intends them for doctor-supervised clinics.

If nurses run your Coumadin clinics, you should continue to use 85610 (Prothrombin time). The only time you'll report an E/M code (such as 99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ) is if this evaluation service is medically necessary and is distinct and separately identifiable.