Coumadin Management

I read the artical regarding pt/inr, but still have a few questions. If the patient is not having their pt/inr checked in the office (ex. they go to a lab and have the results faxed to the office) and the coumadin is managed over the phone can we bill for the management (G0250, 99363, and 99364 as appropriate) or are these "face to face" services? If I am unable to bill these services how do O bill the management of patients going to the lab and being followed over the phone?
Thank you.

as I recall

the telephone management codes require a certain number of protimes every 90 days and most of my patients are on q4 week cycles so I can't bill it- the service is considered "bundled" into the E&M for the visits when you do see the patient.

So that is why you should buy your own machine and do protimes in the office! You also do not lose patients to followup- they walk out the door with their next appointment. I just had a guy who used a hospital lab for his protimes "disappear" for 6 months- he was great about testing then poof-gone. Ends up he lost his insurance and could not afford the hospital bill so he stopped going without telling us. If he had clotted off his valve or bled, we would have been liable for losing track of him. So now it's in my office or at a coumadin clinic or find another doc!