susie09
Networker
Can we bill CPT 99211 when a patient comes in only for a protime
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Wiki E&M and Protime
- Thread starter susie09
- Start date
mitchellde
True Blue
No you cannot. You use the blood collection code. You have no significant medical service other than the blood collection to render therefore there is no justification for the 99211.
susie09
Networker
Thats what I thought, thanks for your help
Saedron
Networker
I have a provider that bills a 99211 with an INR lab when he has to adjust the coumadin regime. I have not read anywhere where he cannot do this.
mitchellde
True Blue
You need to read up on this. CMS had it stated on multiple transmittals that you cannot use a 99211 for a blood collection encounter. Even though it is a 99211 in order to bill it in addition to the blood collection you must meet the criteria of significant and separately identifiable. In addition the improper use of the 99211 level is still on the OIG work plan of things to look into.
Peter Davidyock
Expert
Your provider is correct Saedron so long as a few requirements are met.
A dosing change is management that influences patient care. So long as the rest of the record indicates evaluation (ie HX)
There is quite a bit written on this:
http://www.wpsmedicare.com/j5macpartb/resources/provider_types/emlabservices.shtml
http://medicaleconomics.modernmedic...dle-dreaded-prothrombin-time-99211-?page=full
http://www.omnimedicalsupply.com/Roche/Reimbursement CoagHandbook 2009.pdf
Remember that PT/INR with no dosing change or patient education = PT/INR only.
The last caveat to this is that the medication adjustment direction to the patient MUST take place face to face. This is the killer for billing 99211. In most cases the patient will come into the office/be triaged/has the blood draw and leave. If the physician decides to change the dosing he/she will instruct the nurse and the nurse will call the patient to update the dose. In this scenario the "M" part of E&M has not happened face to face and that effectively nullifies the ability to bill 99211.
A dosing change is management that influences patient care. So long as the rest of the record indicates evaluation (ie HX)
There is quite a bit written on this:
http://www.wpsmedicare.com/j5macpartb/resources/provider_types/emlabservices.shtml
http://medicaleconomics.modernmedic...dle-dreaded-prothrombin-time-99211-?page=full
http://www.omnimedicalsupply.com/Roche/Reimbursement CoagHandbook 2009.pdf
Remember that PT/INR with no dosing change or patient education = PT/INR only.
The last caveat to this is that the medication adjustment direction to the patient MUST take place face to face. This is the killer for billing 99211. In most cases the patient will come into the office/be triaged/has the blood draw and leave. If the physician decides to change the dosing he/she will instruct the nurse and the nurse will call the patient to update the dose. In this scenario the "M" part of E&M has not happened face to face and that effectively nullifies the ability to bill 99211.
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