Author Topic: Coumadin  (Read 8259 times)

jcbilling

  • Full Member
  • ***
  • Posts: 156
Coumadin
« on: September 24, 2009, 02:06:40 AM »
I'm having difficulty understanding the correct way to bill for coumadin checks to Medicare.

The family practice I bill for uses the following codes:

99212-25
85610-QW, GA
36416-59

The 85610 gets paid but the 36416 does not. And since it's done by fingerstick, G0001/36415 does not apply. The Medicare rep told me that 36416 bundles with any other procedure or line item on the claim. But I have searched all the CCI edits and can't find that it does.

The commercial carriers will pay for the 36416 with the -59 modifier.

The office manager of the office I bill for is persistent that there must be a way another code to use, because she said they are losing money on these, especially if the patient comes in for office visit with the doctor on the same day. They only get reimbursed the 5.42 on the 85610 - ouch!

Any suggestions?

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: Coumadin
« Reply #1 on: September 24, 2009, 11:00:43 PM »
You didn't mention if the 99212 is being paid or not.  It looks like it is coded properly, if they are bundling the 36416 the way you have it coded I am not sure there is anything you can do.  You could ask for a review and state why you disagree with the bundling.

Good luck
Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

jcbilling

  • Full Member
  • ***
  • Posts: 156
Re: Coumadin
« Reply #2 on: September 25, 2009, 11:21:31 AM »
HI Michelle,

They pay for the 99212 if they come in just for the coumadin. But in that case, is the -25 modifier even appropriate since the 85610 is the reason for the visit.

~ Charity

Steve Verno CMBS, CEMCS

  • Full Member
  • ***
  • Posts: 118
Re: Coumadin
« Reply #3 on: September 25, 2009, 01:18:06 PM »
IM on Coumadin.  My cardiologit established a Coumdin clinic within his practice.  The coumadin checks are done by the practice nurse on Tuesdays only. That is when my cardiologist is in the office.  The Coumadin checks are done as part of Incident to services. The nurse does a finger stick and voila, I am within Coumadin parameters or I need an increase/decrease in doseage. 

They bill the following:  99211 (25) and 85610. 

All claims are paid by my Government Insurance Carrier. My insurance pays $5.54 for the 85610.

On a side note, we DONT code because an office manager doesnt like what is being paid for services rendered and because that payment is low.  To find another code as a means of increasing revenue, when that code is not appropriate for what was documented and performed, could be called upcoding and upcoding may be illegal in many states and it could be called fraud.

With me, the 99211 is appropriate because it follows Incident To rules. 
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.

Pay_My_Claims

  • Guest
Re: Coumadin
« Reply #4 on: September 25, 2009, 01:37:29 PM »
*smiles*

Medical Billing Forum

Re: Coumadin
« Reply #4 on: September 25, 2009, 01:37:29 PM »

jcbilling

  • Full Member
  • ***
  • Posts: 156
Re: Coumadin
« Reply #5 on: September 25, 2009, 10:19:05 PM »
Hi Steve -

I completely agree about not upcoding just to receive higher pay. That is why I'm inquiring about this situation. However, on the flip side, I also want to be sure my clients are receiving the best reimbursment possible for the services they provide. 

Thanks for the help,
Charity

updastE

  • Full Member
  • ***
  • Posts: 139
    • stromectol 3 mg tablet
Re: Coumadin
« Reply #6 on: October 26, 2022, 09:20:44 PM »
Hempstead J <a href=http://stromectol.autos/>ivomec</a> The Tg ubi Zebrabow S a132 line referred to as ubi Zebrabow S or line S shows Mendelian inheritance consistent with a single transgene

ZooxySeno

  • Jr. Member
  • **
  • Posts: 59
    • molecular docking of tamoxifen
Re: Coumadin
« Reply #7 on: November 08, 2022, 01:14:43 AM »
droperidol and haloperidol both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome <a href=https://nolvadex.one/>purchase tamoxifen citrate online</a> 233 282 1997

royagma

  • Sr. Member
  • ****
  • Posts: 326
    • generic of furosemide bad for your kidneys
Re: Coumadin
« Reply #8 on: November 15, 2022, 11:11:41 PM »
Cells were lysed in 1 SDS lysis buffer and boiled to disrupt chromatin, and lysates were immunoprecipitated with anti Flag antibody <a href=https://lasix.autos/>furosemide lasix side effects</a> Presently last week I had a biopsy done on thyroid gland on right side nodule was found

unorgobug

  • Sr. Member
  • ****
  • Posts: 330
    • doxycycline ruined my life
Re: Coumadin
« Reply #9 on: November 19, 2022, 12:27:40 AM »
Gallen, Switzerland; Patrick Neven, University of Leuven; Patrick Neven, University Hospitals Leuven, Leuven, Belgium; IstvГЎn LГЎng, National Institute of Oncology, Budapest, Hungary <a href=https://doxycycline.world/>can doxycycline make you extremely tired</a> However, Huperzine A is still a great Nootropic supplement, and it is very cheap

Medical Billing Forum

Re: Coumadin
« Reply #9 on: November 19, 2022, 12:27:40 AM »

piegmen

  • Sr. Member
  • ****
  • Posts: 326
    • durjoy dapoxetine hcl
Re: Coumadin
« Reply #10 on: December 09, 2022, 04:02:12 AM »
Independent medical experts recommend that women get a bone density screening once they are 65 years old <a href=http://clomid.one>buy clomiphene and gonadotropins</a>

awaixebra

  • Full Member
  • ***
  • Posts: 239
    • taking 2 cialis pills at once
Re: Coumadin
« Reply #11 on: December 10, 2022, 12:26:41 AM »
How long does hair loss last after chemo <a href=http://ccialiss.top>tadalafil generic vs cialis</a> sertraline will increase the level or effect of ivacaftor by affecting hepatic intestinal enzyme CYP3A4 metabolism

Vogegrorb

  • Sr. Member
  • ****
  • Posts: 334
    • is levitra still on the market
Re: Coumadin
« Reply #12 on: December 10, 2022, 05:32:39 AM »
2013 Oct 1; 192 237 45 <a href=https://ccialiss.icu>cialis cost</a>

lapound

  • Sr. Member
  • ****
  • Posts: 340
    • do you have to use finasteride forever
Re: Coumadin
« Reply #13 on: December 20, 2022, 01:28:28 AM »
In line with these observations, more recent in vitro studies by Yuan et al <a href=http://cialis.pics>buy liquid cialis online</a>

ideorrert

  • Sr. Member
  • ****
  • Posts: 304
    • liquid clomiphene dosage
Re: Coumadin
« Reply #14 on: January 26, 2023, 07:39:12 AM »
<a href=https://accutane.buzz>accutane overnight</a> Glaumann S, Nopp A, Johansson SG, et al

Medical Billing Forum

Re: Coumadin
« Reply #14 on: January 26, 2023, 07:39:12 AM »