Internal Medicine Coding Alert
Copayments With Prothrombin Time
Question: We have just started to bill for Prothrombin Time (PT) in our office for patients who are on Coumadin, and some of these patients must come in two to three times a week. How do I handle the issue of copayment for these patients when theyre being seen more than once a week?
New York Subscriber
Answer: According to Kathy Pride, CPC, CCS-P, coding supervisor at Martin Memorial Medical Group in Stuart, Fla., the issue of copayments would depend on each patients insurance coverage. If you are being reimbursed less the copayment, then you should collect the copayment every time. If you are being reimbursed in full, then you probably shouldnt be collecting the copayment. Check your carriers explanation of benefits (EOBs) for an indication as to whether you should collect a copayment. Some contracts, particularly commercial insurance companies, exempt certain procedures and tests from copayments. You should make the decision on a case-by-case or carrier-by-carrier basis.
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