Pulmonology Coding Alert

Practices might report 99211 in addition to 85610 because patients who come in for Coumadin monitoring can have co-existing conditions or complications that arise from time to time. These are exceptions, however, and you should consider each case individually. Routine separate billing of 99211 for this group of patients is not encouraged -- or appropriate.

According to TrailBlazer's policy on prothrombin time, "a physician visit is not routinely necessary to draw blood for a prothrombin time or other laboratory tests. Therefore, the documentation for code 99211 or any other E/M code in this circumstance must demonstrate a need for clinical evaluation and management."

"Alternatively, for patients who have no new clinical concerns, documentation that contemporaneous laboratory values were obtained, reviewed, and used to guide current and/or future therapy documents that a separately payable E/M service has been performed," according to TrailBlazer, the Part B carrier for Delaware, Maryland,Virginia, Texas, and Washington, D.C.

For example, if the NPP takes the patient's vital signs to assess the patient's hypertension, checks for bruises due to patient complaints, discusses medication compliance,gives dietary instruction, and then documents these services, you might be able to report 99211.

Of course, this is assuming there is documentation indicating medical necessity and the physician is present in the office suite during the service (a requirement of billing 99211).