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Pulmonology Coding Alert

READER QUESTIONS:

Code Carefully on E/Ms With Coumadin Tests

Published on Mon Feb 23, 2009

Question: If a qualified nonphysician practitioner (NPP) performs a finger-stick Coumadin test, can we report a low-level E/M, such as 99211, in addition to the test code? Ohio Subscriber Answer: As long as your NPP did not simply perform the test, and he has clearly documented the medical necessity for an E/M visit, you may use 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) in addition to 85610 (Prothrombin time) with modifier QW (CLIA waived test) appended. Note: Keep in mind that any office can bill for a CLIA-waived test. You just need to make sure you have a CLIA certificate to bill for tests that are not CLIA-waived. 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 [...]
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