Anticoagulant management
March 3rd, 2009 - Codapedia Editor
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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