Oncology & Hematology Coding Alert

Question: Can we use 99211 (Office or other outpatient visit) for the time a nurse spent administering a prothrombin time test? What documentation should we provide?

Missouri Subscriber

Answer: Medicare pays the pathology laboratory that performed the prothrombin test (85610) and considers anticoagulant monitoring services - such as monitoring test results, evaluating the patient and adjusting dosages - as part of an E/M service. But you may bill 99211 when a nurse discusses the prothrombin time test (85610) and schedules the next test with a patient in the office.
 
Also, the physician doesn't have to be present, but should be available if needed. For example, if the patient had side effects from the anticoagulant drugs, such as vomiting (787.0x) or fever (780.6), your nurse could request that your physician provide treatment.