Primary Care Coding Alert

Get ready for the new edition, effective Jan. 1 If you-ve been wondering how you should report ventilation assist and management in the hospital or nursing facility, look no further. CPT 2007 rings in the new year with several new codes that will help family practice physicians bill these claims more accurately. Break Down Vent Management by Site In the past, coders may recall reporting 94656 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) and 94657 (-subsequent days) for ventilation management. But CPT has deleted those codes, and now you can bill based on where the physician administered the ventilation management, as follows:

- 94002 -- Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day

- 94003 -- ... hospital inpatient/observation, each subsequent day

- 94004 -- ... nursing facility, per day

- 94005 --  Home ventilator management care plan oversight of a patient (patient  not present) in home, domiciliary or rest home (e.g., assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes 
or more. Streamline Coumadin Management Coding CPT 2007 also introduces two new codes that will help physicians who perform warfarin sodium management:

- 99363 -- Anticoagulant management for an outpatient taking warfarin,  physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR  measurements)

- 99364 -- Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INR measurements).    Family physicians use Coumadin, or warfarin sodium, to thin a patient's blood to prevent heart attacks (410.xx), strokes (431-436), and complications from other disorders, such as deep venous thrombosis (451.1x). Because too much Coumadin can lead to fatal bleeding, the physician uses a finger stick to monitor the patient's blood clotting speed, which provides him with almost instant results.

Breakthrough: Coders normally report 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for the finger stick and 85610-QW (Prothrombin time; CLIA waived test) for the lab test. But family medicine practices faced problems when trying to report 99211 along with the visits. This new code might help eliminate those problems.

-I am delighted to see that we now have codes to capture anticoagulant management,- says Sheldrian Leflore, revenue management educator with The Coding Group in Carlsbad, Calif.

-This will be a welcome addition for practices with protime or coumadin clinics. There has not been a CPT code to effectively describe this service. Also, [...]