Pathology/Lab Coding Alert

Question: A 59-year-old patient is on Coumadin for his cardiac arrhythmia. He came in for a follow-up evaluation. The physician ordered a prothrombin time test, performed by the physician office lab, to see how quickly the patients blood was clotting. How should we code this visit?

Colorado Subscriber

Answer: You should report the appropriate-level E/M office visit code (99211-99215) for the physician evaluation. Report 85610 (Prothrombin time) for the lab test. If your physician office lab operates as a waived-status lab under the Clinical Laboratory Improvement Amendments (CLIA), you must use one of the waived tests such as AvoSure Pro by Avocet Medical Inc. or ProTime Microcoagulation System (ProTime 3 Cuvette) by International Technidyne Corp. CLIA-waived labs must report the test using modifier -QW (CLIA-waived test)
 
For the diagnosis, list V58.61 (Long-term [current] use of anticoagulants) to indicate to the payer that the physician is following the patients blood condition regularly. You should also code the cardiac arrhythmia as a secondary diagnosis (for example, 427.9, Cardiac dysrhythmias; cardiac dysrhythmia, unspecified).
 
Medicare has placed frequency restrictions on prothrombin time testing as indicated in the National Coverage Determination available online at http://www.cms.gov/ncd/labindexlist.asp. If you think the test may exceed frequency limitations, have the patient sign an advance beneficiary notice (ABN) before the visit so the patient is responsible for payment if the claim is denied.