Anticoagulant management

March 3rd, 2009 - Codapedia Editor
Categories:   Evaluation & Management (E/M)   Specialty Coding  
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In 2007, CPT® added two codes for anticoagulant management, 99363 and 99364.  The codes are meant to be used by physicians and Non-Physician Practitioners (NPPs) who manage a patient's warfarin therapy on an outpatient basis, reviewing the PTINR, adjusting the patient's dosage as appropriate, and communicating with the patient.  The initial management is for a 90 day period, and must include at least 8 INR measurements. The second code is for subsequent 90 days of therapy, and must include at least 3 INR measurements.

The codes are not to be used to report the work of an E/M service or care plan oversight.

Unfortunately, CMS assigned the codes the status indictator of  B for bundled. This means, you will not be reimbursed by Medicare if you report these codes.  You may not bill a Medicare patient for these services, whether or not you have the patient sign an ABN, because you cannot bill a patient for bundled services.

These codes may be used for commercial payers.  Their payment policies will vary, of course.

Why are there CPT® codes with no payment?  The AMA develops CPT® codes based on services physicians are providing.  Physicians request new codes to describe the services they are doing, through a formal process described at the beginning of the CPT® book.  CMS then develops payment policies, independently of the AMA.  In this case, CMS's policy does not allow carrier's to pay for the service.

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