Medical Billing Coding - PT/INR, cpt, codes
medical billing and coding forum

BC Advantage Magazine


General Medical Coding Forum

New Topic  |  Search

Thread Topic: PT/INR
Topic Originator: Cindi
Post Date May 7, 2008 @ 11:56 AM

May 7, 2008 @ 11:56 AM Reply  |  Email Friend   |  |Print  |  Top

How do you bill for a PT/INR?  Our doc's want to bill a 99211 on everyone. Could someone give me some info on how you bill for it?

Thanks so much!

Steve Verno
May 7, 2008 @ 3:29 PM Reply  |  Email Friend   |  |Print  |  Top

The folowing is from an article on this topic by Steven Adams, CPC, CPC-H, COA and Dan Johnson, CPC, CPC-H, Practice Management and Coding Consultants for MAG Mutual Healthcare Solutions, Inc.

Frequently physicians ask, I have many patients on Coumadin (Warfarin Sodium)

Therapy. Currently many of them receive their PT INR tests in my office. Is it appropriate to bill 99211 (nurse code) for this service?
The answer is not simple. In fact, it would be impossible to discuss in this brief article every possible correct and incorrect use of CPT code 99211. However we can cover the basics so your office is more likely to be reimbursed, and you are more likely to bill this code in compliance with CMS guidelines.

According to Medicare: even though the 99211 code does not require the presence of the physician in the patients room or a face-to-face encounter with the physician, the service would be done by face-to-face encounter with the physicians staff and incident to (the physician must be in the office suite and immediately available.) a physicians service.

In other words, CPT code 99211 does require a documented face-to-face evaluation by a physicians staff member and a physician service (change in a medical regimen) that has an impact on the patients care.

Medicares statement gives us three general questions to ask when evaluating the appropriate use of CPT code 99211. Remember, these questions must be answered affirmatively when deciding whether or not to use CPT code 99211.

1. Was the Incident to rule met (was the provider on site)?

2. Was the service medically necessary and not just routine (there must be a change in the medical regimen performed while the patient is in the office)?

3. Was the service face-to-face (did you or a staff person talk to the patient in person and not via phone)?

The following example supports the use of CPT code 99211 for PT/INR testing in the physicians office:

Àƒ The patient taking Coumadin Warfarin Sodium comes in for a routine PT/INR test

Àƒ A provider (MD, DO, NP,PA) is in the office so the visit meets the incident to requirement

Àƒ The nurse performs the PT INR test and shows the results to the provider while the patient is still in the office.

The PT INR levels indicate a needed change in the anticoagulant dosage. This also meets the medical necessity requirement

Àƒ The nurse informs the patient of the changes and documents this in the patients record while the patient is in the office which meets the face-to-face requirement

The following situations do not meet the requirements for billing CPT code 99211.

a. CPT code 99211 is billed for a staff member giving an injection ordered by the physician. CPT code 99211 cannot be billed solely for the purpose of administering an injection or collecting a specimen for a diagnostic test. Billing codes for injections and collecting specimens already include an RVU (relative value unit which includes payment for staff time, malpractice premiums and physician work time) for physician and staff involvement.

b. When CPT code 99211 is billed for routinely documenting a history and vital signs in order to support another CPT code. Documenting vital signs that do not impact the patients care does not support using 99211 with another CPT code. Checking a patients vital signs as part of a drug administration encounter would be a component of the drug administration codes, as would observing the patient for a response to an injection.

c. When billing CPT code 99211 for performing PT INR levels and no dosing or medical regimen change is made. This applies to many office-based diagnostic tests. In these circumstances, the requirements of CPT code 99211 are not met.

d. When the patient leaves and a telephone call is later made to give patient instructions. CPT code 99211 should not be billed as a face-to-face evaluation or management (E&M) service since the patient was not in the office and the results and instructions are not provided face-to-face.

From a risk perspective, patients are probably more compliant with necessary testing when they are able to a have their tests such as PT INR performed in their physicians office. The additional trip to the laboratory or hospital may be burdensome to the patient and communication of routine results may not be as reliable. Yet physicians sometimes say they cannot provide these services without experiencing negative revenues.

May 12, 2008 @ 6:22 PM Reply  |  Email Friend   |  |Print  |  Top

But wouldn't code 99363 accomplish the same thing without the criteria restricting 99211?

June 11, 2008 @ 4:44 PM Reply  |  Email Friend   |  |Print  |  Top

99363 is only for the first initial 90 days.

We have a Coumadin Clinic in our office.  We always bill a 99211 if the patient did not see the physician.  We have a series of questions we ask regarding complications and history, then obtain blood pressure, heart rate and document everything in our computer system.  The PT/INR is done and the physician or PA is notified of the result.  They document and sign the note resulting in meeting the criteria for 99211.  Our nurse or MA performs this visit except the decision making that the provider does.
I hope this helps.

June 11, 2008 @ 6:00 PM Reply  |  Email Friend   |  |Print  |  Top

I was recently placed on coumadin and had a PT/INR done by the office LPN. I was never seen by the physician. I just received a bill for a 99215 visit.  I guess I will plan on speaking to their coder as to why every visit is a level 5 visit,especialy one where there was no hx, exam or mdm.

June 25, 2008 @ 9:53 AM Reply  |  Email Friend   |  |Print  |  Top

Suzanne could you plez send me your email address so I can ask you more specific questions.  Thanks

July 8, 2008 @ 12:29 PM Reply  |  Email Friend   |  |Print  |  Top

Donna -  please send me an email at

July 8, 2008 @ 12:34 PM Reply  |  Email Friend   |  |Print  |  Top

The only visit type that would qualify a nurse visit is the 99211.  A facility cannot bill any other E&M visit without a face to face visit by a provider.

July 9, 2008 @ 10:05 AM Reply  |  Email Friend   |  |Print  |  Top

I work for a Family Practice clinic, where a lot of our patients come in for checks on their coumadin levels.  Usually, the nurses do the PT/INR and I only bill 85610 for the lab test. If one of my doctors sees the patient, ie. drug monitoring, etc., then I will bill the 99212 and the 85610/V58.61. Hope this helps.

Copyright © 2008 Billing-Coding Inc