Pathology/Lab Coding Alert

Question: We operate a physician-office lab that monitors coumadin levels in patients on anticoagulants. The nurse asks the patient a list of questions before performing the Protime test. Can we charge an evaluation and management fee such as 99211 in addition to the lab fee for the test?


Georgia Subscriber

Answer: You should bill the lab test as 85610 (Prothrombin time). If the list of questions the nurse asks prior to a blood draw is standard procedure for every patient, this would be part of a typical or routine Protime check and would not justify billing a separate E/M servicesuch 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. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services).
 
For you to be able to bill 99211, the documentation must support that staff provided a separate E/M service in excess of that typically provided to a patient just coming in for the test. You must document medical necessity, such as noting that the patient is having difficulties with the medication. Also, for Medicare (and some other payers), you must meet incident-to guidelines, which means, among other criteria, that the physician be in the office suite.