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Coumadin Clinic Codes New for 2007
(PYA Alert dated December 12, 2006)
The American Medical Association has established two (2) new 2007 CPT E/M codes for the care, management and monitoring of patients on Coumadin therapy.
99363
Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements)
99364
Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INR measurements)
Coders beware! At the current time, the Centers for Medicare and Medicaid Services (CMS) consider these codes to be bundled with other services and has assigned a status indicator of “B” to these codes.
Bundled (B) = Bundled Code. Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amount for these codes, and no separate payment is made. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient.)
The Relative Value Update Committee (RUC) of the American Medical Association has recommended the following RVU’s for reimbursement of these codes by payors:
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Non-Facility |
Facility |
99363 |
3.01 |
2.10 |
99364 |
1.05 |
.82 |
Until CMS makes a decision to reimburse these codes in 2007, you may only be able to use them with private payors. Each payor should be contacted to determine if coverage is allowed for these new codes beginning January 1, 2007.
If you would like more information, please contact Maggie Mac at (800) 270-9629.
The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only. Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.
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