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Anticoagulant management

Kathy Posted Mon 27th of August, 2012 18:52:52 PM

What would the billing DOS be for reporting initial anticoag code 99363 - the date of initiation or the last date of the specific billing period?

SuperCoder Answered Tue 28th of August, 2012 17:54:58 PM

The CPT codes are intended for the active management of a patient on anticoagulation (warfarin) and require the physician to submit a bill every 90 days.

CPT code 99363 is to be used after the initial 90 days of outpatient warfarin therapy. The code is intended to reimburse the physician work involved in adjusting warfarin levels based on a review of a patient’s international normalized ratio (INR) measurements. The code language requires that a physician record at least eight INRs in the 90-day period in order to report the code. Any work that a physician performed related to this management cannot be considered when determining the level of any E/M code reported during this time period. The physician should bill the code on the 90th day of management.

CPT code 99364 is very similar, but is to be used for subsequent 90-day periods of management and only requires three INR measurements during these time periods.

Despite these guidelines, coding and payment policies of non-Medicare insurers may still vary. They might or might not reimburse separately for the anticoagulant therapy management CPT codes 99363 and 99364. Physicians should check with insurers to determine their payment policies.

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