Primary Care Coding Alert
Coumadin Coding
Question: When patients come in to have their Coumadin therapy monitored, are we allowed to bill a nurse visit (99211)? And should we use the ICD-9 code for the Coumadin follow-up or for the reason the patient was put on the Coumadin? Nevada Subscriber Answer: For Coumadin visits, if a nurse takes the patient's vital signs, asks about changes in diet or easily bruising skin, offers counseling, or changes the medication, you can bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician). If the physician sees the patient and performs all of the above, he or she can code 99212 or a higher-level E/M, if the visit was thoroughly documented.
answer.
Don't use 99211, however, if the nurse only draws blood. In that case, use 36415* (Routine venipuncture or finger/heel/ear stick for collection of specimen[s]) for third-party payers and G0001 (Routine venipuncture for collection of specimen[s]) for Medicare. If you conduct a prothrombin time test, report 85610 (Prothrombin time).
For the primary diagnosis code, use the reason that the patient was originally on Coumadin. As a secondary code, use V58.61 (Long-term [current] use of anticoagulants).
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