Can I bill for coumadin management over the phone?

March 10th, 2009 - Codapedia Editor
Categories:   Coding   Compliance   Primary Care|Family Care  
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A physician asks:  "Can I bill for coumadin management for patients in the nursing home?  I sometimes get 25 calls a month with PTINR results, and have to make decisions about the patient's coumadin dose.  Can I bill for that?"

Unfortunately, no.

Medicare considers this part of the pre and post work of an E/M service, and does not reimburse it separately.  There are CPT® codes for this service: 99363 and 99364, but they have a status indicator of bundled and so are not separately reimburseable.  The CPT® Care Plan Oversight codes 99374--99380 are also not paid by Medicare.  These do describe CPO of patients in a nursing facility, 15-29 minutes/month, or over 30 minutes.

Medicare's own HCPCS CPO codes do not inculde the care of nursing home patients, only HHA and hospice patients. 

There is no separate reimbursement for managing a nursing home patient's coumadin dose based on updated INR data over the phone.

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