Pediatric Coding Alert

Question: How should I code for monitoring Protime when the patient has gone to the laboratory for the test and the pediatrician receives the report for review and dose adjustment?

New Jersey Subscriber

Answer: If your pediatrician discusses the Protime results with the patient's guardian over the phone, you may bill a telephone call (99371-99373, Telephone call by a physician to patient for consultation or medical management or for coordinating medical management with other healthcare professionals ...) for reporting the results. You could then bill the balance to the patient if the insurer denies 99371-99371 as a noncovered service.

Unless a face-to-face service occurs with the patient, you cannot charge an office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for this service. If your pediatrician documents the review in the chart, you may be able to count the medical decision-making in the next visit's service. The data review could possibly raise the level of medical decision-making, thereby increasing the E/M service's level (99212-99215). 

But you may use 99212-99215 when the pediatrician shares the Protime results with the patient during a face-to-face encounter. If the pediatrician assesses the patient, reviews the Coumadin dosage and provides information to the patient such as when to return for another Protime, when to follow up with the physician, and to call if unusual bruising occurs or blood is seen in the urine, you should bill the appropriate office visit code (99212-99215).