Wiki Management of PT/INR

[missyah20]

We have a clinic we bill for and they will see patients at the clinic for a lab draw to manage PT/INR. The lab draws are initiated by cardiology but because of the patient's proximity to the clinic they perform the labs, with results faxed back to our providers) to manage the warfarin(anticoagulants).

What is the appropriate way to bill for this? Just the 36415 for the lab draw?

 

[CBLENNIE]

Am I interpreting your statement "the clinic they perform the labs" to mean that the clinic is not only doing the blood draw, but they actually are running the labs in house and providing the results back to the ordering provider?

If the clinic is running the lab in house, and the lab test being performed is Prothrombin time CPT 85610, assuming your clinic has a CLIA Certificate of Waiver (COW) or any of the other CLIA certificates, you should be able to bill for the lab test in addition to the blood draw. If you only have a CLIA COW, then you need to need to bill 85610 with modifier QW to indicate this test is CLIA waived. If you don't have any of the various CLIA certificates, then you cannot perform and bill for any lab test, all you will be able to bill for is the blood draw with CPT 36415.

 

[missyah20]

This clinic does have their CLIA certificate, but from my understanding this specific lab isn't run at the clinic itself and is sent out. I will, however, verify that with the provider. So if they aren't running the lab test at the clinic would it just be the 36415? It is my understanding that the providers at the clinic will review the lab tests and possibly make medication adjustments based on that, but that would not be billable since it wasn't done at the time of the pt visit, correct?