cmontgomery
Contributor
We do Protimes (85610) on patients taking coumadin in our office. We used to just bill out 99211, 85610-QW and 36415-59 with a diagnosis of v58.61. The nurse would complete a med list review, perform a complete set of vitals and question the patient regarding bleeding, bruising etc. We were paid with no problems. Suddenly just recently Novitas will not pay for the 99211 as they state it is included with the 36415 and they stated to append a mod 25 to the 99211. Since they stated that, we started adding the primary reason the pt was on the coumadin, say 427.31, linking the 99211-25 to that dx code and linking the 85610-QW and 36415-59 only to the v58.61. I didn't want to add a mod25 but even when linking with its own diagnosis code, they stated it would not be paid without the modifyer. Can anyone out there advise me if this is correct or how would you do it differently? This case scenario is the only time we bill a 99211 as it stated in CMS guidelines previously that this would be acceptable when doing protimes in office.