RE: Reimbursement for managing anticoagulation

[Guest guest]

No -- there's a code but noone pays for it.

Some docs use the machine in the office, but concensus is that it's a wash, unless you bring pt in for each and every time.

In my area, no patient would do this, and the local cardiology group did this for awhile, then stopped it.

Now I'm ready for the argument from those here who see, adjust coumadin and charge a visit for each of these.

Matt in Western PA

REimbursement for managing anticoagulation

I have a number of pts on warfarin whom I am managing. The time it takes to review lab, review current dose, adjust/record changes, call/email patient with instructions is significant x 12. Does anyone know if there a way to be reimbursed for this?

[Guest guest]

I'm not sure why you wouldn't want to bring the

patient in each and every time. You're managing a

high risk medication month to month and you're paying

the malpractice insurance company and your office

overhead to be able to do it.

Having the patient come in so you can do your job is

just part of the deal from my perspective. It could

be done on a virtual visit basis or with a nurse visit

I suppose, but I wouldn't do it for free since it's

costing you time and overhead to provide the service.

Physicians in my area typically bill an E & M level of

service and code Atrial fib or Valvular Heart Disease,

DVT or whatever the main underlying problem is in

addition to the V code for Coumadin management. There

is often HTN or DM or some other chronic condition

that we touch on as well.

Ben

--- Dr Levin wrote:

> No -- there's a code but noone pays for it.

> Some docs use the machine in the office, but

> concensus is that it's a wash, unless you bring pt

> in for each and every time.

>

> In my area, no patient would do this, and the local

> cardiology group did this for awhile, then stopped

> it.

>

> Now I'm ready for the argument from those here who

> see, adjust coumadin and charge a visit for each of

> these.

>

> Matt in Western PA

> REimbursement for

> managing anticoagulation

>

>

> I have a number of pts on warfarin whom I am

> managing. The time it

> takes to review lab, review current dose,

> adjust/record changes,

> call/email patient with instructions is

> significant x 12. Does anyone

> know if there a way to be reimbursed for this?

>

>

>

>

________________________________________________________________________________\

____

Looking for last minute shopping deals?

Find them fast with Yahoo! Search.

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

[Guest guest]

I use the ICD 9 codes for high risk medication, a V code and the code for AF or

whatever. I do vitals, and a brief history for issues and I bill a level 3 visit

and a venpuncture code since I draw the blood. I get paid for both and this

compensates for the phone time.

________________________________

From: on behalf of fammedtopeka

Sent: Wed 1/2/2008 5:48 PM

To:

Subject: REimbursement for managing anticoagulation

D

I have a number of pts on warfarin whom I am managing. The time it

takes to review lab, review current dose, adjust/record changes,

call/email patient with instructions is significant x 12. Does anyone

know if there a way to be reimbursed for this?

[Guest guest]

You mean to tell me that you see a pt EVERY SINGLE TIME just to review a protime and adjust the coumadin?

This means when a pt is discharged from the hospital, you'd see them, maybe, every 2-3 days for 3 weeks, then every 1 week, then every 2 weeks, then every 3-4 weeks, and BILL THEM FOR THAT VISIT?

Hmmmmmmmm.........................

How do you change diabetic medications for glucoses, or insulin dosages?

Pardon my capitalization and cynicism, but I just don't get it...............

Matt

REimbursement for> managing anticoagulation> > > I have a number of pts on warfarin whom I am> managing. The time it > takes to review lab, review current dose,> adjust/record changes, > call/email patient with instructions is> significant x 12. Does anyone > know if there a way to be reimbursed for this? > > > > __________________________________________________________Looking for last minute shopping deals? Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping

[Guest guest]

I'd append below that I don't draw labs in my office............

How much do you get paid for the draw?

I do see these pts if stable every 3-6 months, often more frequently for other issues, but NOT for each and every protime adjustment.

Would not fly here, guys, everyone uses coumadin flow sheets.

Can you show me a study advising pts to see a doc with every protime review and adjustment.

Matt in Western PA

REimbursement for> managing anticoagulation> > > I have a number of pts on warfarin whom I am> managing. The time it > takes to review lab, review current dose,> adjust/record changes, > call/email patient with instructions is> significant x 12. Does anyone > know if there a way to be reimbursed for this? > > > > __________________________________________________________Looking for last minute shopping deals? Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping

[Guest guest]

I generally bring the patient in for a “paying”

visit every 3 – 4 times I review an INR.    Most of these patients have lots

of other problems, so there is no need for “creative billing.”  I

simply tell the patient at the beginning that I will have them get the blood

drawn at the lab, with no co-pay, for the majority of their blood draws, but

that they will have to schedule a “real” visit with me to review

things every few months, or more often if they are complicated. 

I do use the INRatio machine in the office, and it is a wash, 

so I only use it during “real” visits, when we can discuss the

results face-to-face at the time of service.   It is a real convenience for me,

however, to get the results during the visit.   My patients usually get their “no-copay”

INR drawn at a LabCorp draw station located at my previous office, and they do

get the results at the time of service.  The results are faxed to me within

about an hour, and I review the faxes and email my instructions before I “go

home” in the afternoon. 

By the way, I happened to get two INRatio machines when I set up

the office. They were included in a bulk purchase deal when I got a year’s

 worth of Cholestech cassettes and a couple of Cholestech machines at a good

price.  I would be happy to sell one brand spanking new-in-the-box INRatio

machine to an IMPer  for $100.00 if anyone wants one.   Remember, this is a “break-even”

test, and the media costs about $4.00 each, so you will not possibly make money

on the deal (unless you have patients you can convince to come in for a “real

visit” every time they need an INR. )    I think the INRatio machines

list at over $1,000.00 new, so you could probably even sell it on e-bay and

make a profit, but I have enough on my plate without trying to sell things on

e-bay.    The machines are quite accurate, and are not hard to use, though

there is a learning curve to getting a big enough drop of the patient’s

blood on just the right spot on the sensor. 

T. , MD

Sammamish Diabetes and Lipid Clinic, PLLC

In business since the last week in July, 2007.  Finally got my

Medicare approval on December 31, just too late  to change my status for the

next year. 

From:

[mailto: ] On Behalf Of Dr Levin

Sent: Wednesday, January 02, 2008 4:55 PM

To:

Subject: Re: REimbursement for managing anticoagulation

No

-- there's a code but noone pays for it.

Some

docs use the machine in the office, but concensus is that it's a wash, unless

you bring pt in for each and every time.

In

my area, no patient would do this, and the local cardiology group did this for

awhile, then stopped it.

Now

I'm ready for the argument from those here who see, adjust coumadin and charge

a visit for each of these.

Matt

in Western PA

-----

Original Message -----

From: fammedtopeka

To:

Sent: Wednesday, January

02, 2008 7:48 PM

Subject:

REimbursement for managing anticoagulation

I have a number of pts on warfarin whom I am

managing. The time it

takes to review lab, review current dose, adjust/record changes,

call/email patient with instructions is significant x 12. Does anyone

know if there a way to be reimbursed for this?

[Guest guest]

Matt,

I manage the majority of my Coumadin patients at the

point of care with a Clia waved Protime machine. We

are a rural office and the nearest hospital is 20

miles away so it really is the most convenient way for

us to operate. There are no call backs, no emails are

needed and the feedback is immediate.

I will see a new Coumadin patient as often as needed

to get them stable. Probably 2 times the first week

or two then weekly then q2weeks for a time or two,

then monthly. If I'm making a medical decision about

dosing and managing a high risk medication that will

certainly require an office visit. I don't recall one

complaint from a patient about coming into the office

for a PT in the last 10 years.

Most of these patients are Medicare age and their

share of the office visit is about $12 if they don't

have a secondary insurance. To them a personal visit

with the doctor is worth $12. Less than a virtual

visit.

Insulin and other diabetes meds are preferentially

managed at office visits as well. I have the

patient's labs drawn 2-3 days ahead and we sit down

and go over the results in person. I use the EMR to

catch up on their deferred health maintainance. These

are usual complex visits covering multiple issues.

I will on occasion adjust meds over the phone on

patients that have been in recently and just need a

minor tweak.

Are you paid on capitation or do you make a practice

of not getting paid appropriately for your time and

expertise?

Ben

--- Dr Levin wrote:

> You mean to tell me that you see a pt EVERY SINGLE

> TIME just to review a protime and adjust the

> coumadin?

>

> This means when a pt is discharged from the

> hospital, you'd see them, maybe, every 2-3 days for

> 3 weeks, then every 1 week, then every 2 weeks, then

> every 3-4 weeks, and BILL THEM FOR THAT VISIT?

>

> Hmmmmmmmm.........................

>

> How do you change diabetic medications for glucoses,

> or insulin dosages?

>

> Pardon my capitalization and cynicism, but I just

> don't get it...............

>

> Matt

> REimbursement

> for

> > managing anticoagulation

> >

> >

> > I have a number of pts on warfarin whom I am

> > managing. The time it

> > takes to review lab, review current dose,

> > adjust/record changes,

> > call/email patient with instructions is

> > significant x 12. Does anyone

> > know if there a way to be reimbursed for this?

> >

> >

> >

> >

>

>

>

__________________________________________________________

> Looking for last minute shopping deals?

> Find them fast with Yahoo! Search.

>

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

>

>

>

________________________________________________________________________________\

____

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Nope, I get paid FFS discounted.

However, in our area, Medicare pays about $78 for a 99214, and Medicaid only pays $31.90.

And yes, I do refer in to the local hospital to another FP to do admits, no Ob, no thank you.

But I enjoy managing complex pt care issues, goal of 15 pts/day, usually 99214s on return visits, spending 20-30 min per pt about 35 hours a week.

How many times a week do you go into the hospital before 9 am and home by 6 pm?

Point is, we all live in different areas, have different priorities. I like to run my own place, but as you're well aware, standards of care are different in different communities.

Wish you well -- I NEVER NEVER would have pts seeing me for each and every protime change and insulin or oral agent change. If you can, good for you!

Agree to disagree without getting meanspirited about it?

Matt in Western PA

No, not anonymous, I'm Dr Matt Levin, FP finished in 1988 residency, solo since Dec 2004

REimbursement> for> > managing anticoagulation> > > > > > I have a number of pts on warfarin whom I am> > managing. The time it > > takes to review lab, review current dose,> > adjust/record changes, > > call/email patient with instructions is> > significant x 12. Does anyone > > know if there a way to be reimbursed for this? > > > > > > > > > > >__________________________________________________________> Looking for last minute shopping deals? > Find them fast with Yahoo! Search.>http://tools.search.yahoo.com/newsearch/category.php?category=shopping> > > __________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Phone follow up and clinic follow up for

anticoagulation management have equal outcomes

according to this study in Chest:

http://www.chestjournal.org/cgi/content/full/130/5/1385

It appears that the only thing that has shown better

control really is having appropriate patients monitor

themselves. This is uncommon outside of studies I

would think.

My office visit approach does admittedly increase

upfront costs, but it avoids inducing errors such as:

The patient skipped his protime follow up and I didn't

have a process to catch it.

They had it done, but somehow the result didn't get to

me.

Or - the result came back and I was too covered up to

take action on it the same day.

How we arrive at similar outcomes will be much less of

an issue if and when FPs can ever get paid

appropriately for the complexity and severity of what

we manage.

Regards,

Ben Brewer MD

________________________________________________________________________________\

____

Looking for last minute shopping deals?

Find them fast with Yahoo! Search.

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

[Guest guest]

Hi Don,

I am interested in your INR machine.

Please reply offlist to abuice2002@...

>

> I generally bring the patient in for a " paying " visit every 3 – 4

times I

> review an INR. Most of these patients have lots of other

problems, so

> there is no need for " creative billing. " I simply tell the patient

at the

> beginning that I will have them get the blood drawn at the lab,

with no

> co-pay, for the majority of their blood draws, but that they will

have to

> schedule a " real " visit with me to review things every few months,

or more

> often if they are complicated.

>

>

>

> I do use the INRatio machine in the office, and it is a wash, so I

only use

> it during " real " visits, when we can discuss the results face-to-

face at the

> time of service. It is a real convenience for me, however, to get

the

> results during the visit. My patients usually get their " no-

copay " INR

> drawn at a LabCorp draw station located at my previous office, and

they do

> get the results at the time of service. The results are faxed to

me within

> about an hour, and I review the faxes and email my instructions

before I " go

> home " in the afternoon.

>

>

>

> By the way, I happened to get two INRatio machines when I set up

the office.

> They were included in a bulk purchase deal when I got a year's

worth of

> Cholestech cassettes and a couple of Cholestech machines at a good

price. I

> would be happy to sell one brand spanking new-in-the-box INRatio

machine to

> an IMPer for $100.00 if anyone wants one. Remember, this is a

> " break-even " test, and the media costs about $4.00 each, so you

will not

> possibly make money on the deal (unless you have patients you can

convince

> to come in for a " real visit " every time they need an INR. ) I

think the

> INRatio machines list at over $1,000.00 new, so you could probably

even sell

> it on e-bay and make a profit, but I have enough on my plate

without trying

> to sell things on e-bay. The machines are quite accurate, and

are not

> hard to use, though there is a learning curve to getting a big

enough drop

> of the patient's blood on just the right spot on the sensor.

>

>

>

> T. , MD

>

> Sammamish Diabetes and Lipid Clinic, PLLC

>

> In business since the last week in July, 2007. Finally got my

Medicare

> approval on December 31, just too late to change my status for the

next

> year.

>

>

>

> From:

> [mailto: ] On Behalf Of Dr Levin

> Sent: Wednesday, January 02, 2008 4:55 PM

> To:

> Subject: Re: REimbursement for managing

> anticoagulation

>

>

>

> No -- there's a code but noone pays for it.

>

> Some docs use the machine in the office, but concensus is that it's

a wash,

> unless you bring pt in for each and every time.

>

>

>

> In my area, no patient would do this, and the local cardiology

group did

> this for awhile, then stopped it.

>

>

>

> Now I'm ready for the argument from those here who see, adjust

coumadin and

> charge a visit for each of these.

>

>

>

> Matt in Western PA

>

> REimbursement for managing

anticoagulation

>

>

>

> I have a number of pts on warfarin whom I am managing. The time it

> takes to review lab, review current dose, adjust/record changes,

> call/email patient with instructions is significant x 12. Does

anyone

> know if there a way to be reimbursed for this?

>

[Guest guest]

I used to share Lou and Matt's viewpoint. But I have found that doing the INR in the office is a significant improvement. The reasons are multiple.

1) The patients have scheduled "nursing" appointments. So if they miss their appointment, we can call to remind them. This is very different from the situation where the patient goes to the lab on their own and it can be several months between tests.

2) Results are immeadiately available, so none of those calls after hours from the lab with INR results. No tracking down patients at night. No calling in scripts for dosing adjustments.

3) If there is no change, we bill a 99211 plus veni plus INR. We get around 25 - 30 per visit. If there is adjustment, then I usually speak to patient directly and charge for 99212. They are usually in and out of office in under 15 minutes.

4) If patients choose to do INR at lab, which is usually for insurance and copay issues or for their scheduling convenience, we now charge to provide telephone monitoring and adjustments. We are charging q 3 months somewhere around $45 - $60. So in reality they are not saving money. I believe there are new CPT codes for this and feel no qualms about being appropriately reimbursed for my time.

Mike Safran

More new features than ever. Check out the new AOL Mail!

[Guest guest]

I agree with Ben, I see them, since I also draw the blood to send to the lab in

my office. I do the draw and even Medicare pays $24 to draw the blood. I use to

charge a level 2 visit and the draw, but have been billig a level 3, since I do

vitals, and discuss the issues. Most are stable only here once a month. Although

most have no issues, this is never been an issue of insurance payment.

________________________________

From: on behalf of Ben Brewer

Sent: Wed 1/2/2008 10:00 PM

To:

Subject: Re: Reimbursement for managing anticoagulation

Matt,

I manage the majority of my Coumadin patients at the

point of care with a Clia waved Protime machine. We

are a rural office and the nearest hospital is 20

miles away so it really is the most convenient way for

us to operate. There are no call backs, no emails are

needed and the feedback is immediate.

I will see a new Coumadin patient as often as needed

to get them stable. Probably 2 times the first week

or two then weekly then q2weeks for a time or two,

then monthly. If I'm making a medical decision about

dosing and managing a high risk medication that will

certainly require an office visit. I don't recall one

complaint from a patient about coming into the office

for a PT in the last 10 years.

Most of these patients are Medicare age and their

share of the office visit is about $12 if they don't

have a secondary insurance. To them a personal visit

with the doctor is worth $12. Less than a virtual

visit.

Insulin and other diabetes meds are preferentially

managed at office visits as well. I have the

patient's labs drawn 2-3 days ahead and we sit down

and go over the results in person. I use the EMR to

catch up on their deferred health maintainance. These

are usual complex visits covering multiple issues.

I will on occasion adjust meds over the phone on

patients that have been in recently and just need a

minor tweak.

Are you paid on capitation or do you make a practice

of not getting paid appropriately for your time and

expertise?

Ben

--- Dr Levin <dr_levin@... <mailto:dr_levin%40comcast.net> > wrote:

> You mean to tell me that you see a pt EVERY SINGLE

> TIME just to review a protime and adjust the

> coumadin?

>

> This means when a pt is discharged from the

> hospital, you'd see them, maybe, every 2-3 days for

> 3 weeks, then every 1 week, then every 2 weeks, then

> every 3-4 weeks, and BILL THEM FOR THAT VISIT?

>

> Hmmmmmmmm.........................

>

> How do you change diabetic medications for glucoses,

> or insulin dosages?

>

> Pardon my capitalization and cynicism, but I just

> don't get it...............

>

> Matt

> REimbursement

> for

> > managing anticoagulation

> >

> >

> > I have a number of pts on warfarin whom I am

> > managing. The time it

> > takes to review lab, review current dose,

> > adjust/record changes,

> > call/email patient with instructions is

> > significant x 12. Does anyone

> > know if there a way to be reimbursed for this?

> >

> >

> >

> >

>

>

>

__________________________________________________________

> Looking for last minute shopping deals?

> Find them fast with Yahoo! Search.

>

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping>

>

>

>

__________________________________________________________

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

[Guest guest]

hi, i'm relatively new at billing and have been using the codes on amazing charts. to date i've been unsuccessful in getting paid for drawing blood. what code(s) do you use and do you link it to the primary diagnosis (e.g. atrial fib)? thanksJim.Kennedy@... wrote: I agree with Ben, I see them, since I also draw the blood to send to the lab in my office. I do the draw and even Medicare pays $24 to draw the blood. I use to charge a level 2 visit and the draw, but have been billig a level 3, since I do vitals, and discuss the issues.

Most are stable only here once a month. Although most have no issues, this is never been an issue of insurance payment. ________________________________From: on behalf of Ben BrewerSent: Wed 1/2/2008 10:00 PMTo: Subject: Re: Reimbursement for managing anticoagulationMatt,I manage the majority of my Coumadin patients at thepoint of care with a Clia waved Protime machine. Weare a rural office and the nearest hospital is 20miles away so it really is the most convenient way forus to operate. There are no call backs, no emails areneeded and the feedback is immediate.I will see a new Coumadin patient as often as neededto get them stable. Probably 2

times the first weekor two then weekly then q2weeks for a time or two,then monthly. If I'm making a medical decision aboutdosing and managing a high risk medication that willcertainly require an office visit. I don't recall onecomplaint from a patient about coming into the officefor a PT in the last 10 years. Most of these patients are Medicare age and theirshare of the office visit is about $12 if they don'thave a secondary insurance. To them a personal visitwith the doctor is worth $12. Less than a virtualvisit.Insulin and other diabetes meds are preferentiallymanaged at office visits as well. I have thepatient's labs drawn 2-3 days ahead and we sit downand go over the results in person. I use the EMR tocatch up on their deferred health maintainance. Theseare usual complex visits covering multiple issues.I will on occasion adjust meds over the phone onpatients that have been in

recently and just need aminor tweak.Are you paid on capitation or do you make a practiceof not getting paid appropriately for your time andexpertise?Ben--- Dr Levin <dr_levincomcast (DOT) net <mailto:dr_levin%40comcast.net> > wrote:> You mean to tell me that you see a pt EVERY SINGLE> TIME just to review a protime and adjust the> coumadin?> > This means when a pt is discharged from the> hospital, you'd see them, maybe, every 2-3 days for> 3 weeks, then every 1 week, then every 2 weeks, then> every 3-4 weeks, and BILL THEM FOR THAT VISIT?> > Hmmmmmmmm.........................> > How do you change diabetic medications for glucoses,> or insulin dosages?> > Pardon my capitalization and cynicism, but I just> don't get it...............>

> Matt> REimbursement> for> > managing anticoagulation> > > > > > I have a number of pts on warfarin whom I am> > managing. The time it > > takes to review lab, review current dose,> > adjust/record changes, > > call/email patient

with instructions is> > significant x 12. Does anyone > > know if there a way to be reimbursed for this? > > > > > > > > > > >__________________________________________________________> Looking for last minute shopping deals? > Find them fast with Yahoo! Search.>http://tools.search.yahoo.com/newsearch/category.php?category=shopping <http://tools.search.yahoo.com/newsearch/category.php?category=shopping> > > > __________________________________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ <http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

Looking for last minute shopping deals? Find them fast with Yahoo! Search.

[Guest guest]

I second Mike's email. I prefer to have patients come to the office

for a nurse visit but will allow them to go to the lab if they choose -

but that is more work for me. For the office visits I bill

..PR4: Lab test for Prothrombin time : 85610: QW : : V58.61

..PR: Fingerstick blood draw : 36416

..PR: : 99211

(these are codes in the note that transfer to the billing system

for automatic billing - I use Practice Partner)

Loehr

At 01:27 PM 1/3/2008, you wrote:

I used to share Lou and Matt's

viewpoint. But I have found that doing the INR in the office is a

significant improvement. The reasons are multiple.

1) The patients have scheduled " nursing " appointments. So

if they miss their appointment, we can call to remind them. This is

very different from the situation where the patient goes to the lab on

their own and it can be several months between tests.

2) Results are immeadiately available, so none of those calls after hours

from the lab with INR results. No tracking down patients at

night. No calling in scripts for dosing adjustments.

3) If there is no change, we bill a 99211 plus veni plus INR. We

get around 25 - 30 per visit. If there is adjustment, then I

usually speak to patient directly and charge for 99212. They are

usually in and out of office in under 15 minutes.

4) If patients choose to do INR at lab, which is usually for insurance

and copay issues or for their scheduling convenience, we now charge to

provide telephone monitoring and adjustments. We are charging q 3

months somewhere around $45 - $60. So in reality they are not

saving money. I believe there are new CPT codes for this and feel

no qualms about being appropriately reimbursed for my time.

Mike Safran

More new features than ever. Check out the new

AOL Mail!

[Guest guest]

The code for routine adult Venipuncture is 36415. Many

plans just don’t pay it which is why I don’t draw blood in the office

except for special circumstances. The code for Venipunctue by MD is 36410

and is for venipuncture requiring the expertise of an MD not just that the MD

does it because there is no nurse. No one will care until you get audited

if being used incorrectly. I code this if I must draw from an ankle or

location that a tech or nurse could not usually get or if the lab has failed.

Again, many plans just don’t pay.

I think Medicare and 1 or 2 other plans are the only ones that

pay me for venipuncture. Otherwise it’s just bundled into the

visit.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Lucinda

Grovenburg

Sent: Thursday, January 03, 2008 6:09 PM

To:

Subject: RE: Reimbursement for managing

anticoagulation

hi, i'm relatively new at billing and have been using the codes on amazing

charts. to date i've been unsuccessful in getting paid for drawing

blood. what code(s) do you use and do you link it to the primary

diagnosis (e.g. atrial fib)? thanks

Jim.Kennedy@... wrote:

I agree with Ben, I see them,

since I also draw the blood to send to the lab in my office. I do the draw and

even Medicare pays $24 to draw the blood. I use to charge a level 2 visit and

the draw, but have been billig a level 3, since I do vitals, and discuss the

issues. Most are stable only here once a month. Although most have no issues,

this is never been an issue of insurance payment.

________________________________

From:

on behalf of Ben Brewer

Sent: Wed 1/2/2008 10:00 PM

To:

Subject: Re: Reimbursement for managing anticoagulation

Matt,

I manage the majority of my Coumadin patients at the

point of care with a Clia waved Protime machine. We

are a rural office and the nearest hospital is 20

miles away so it really is the most convenient way for

us to operate. There are no call backs, no emails are

needed and the feedback is immediate.

I will see a new Coumadin patient as often as needed

to get them stable. Probably 2 times the first week

or two then weekly then q2weeks for a time or two,

then monthly. If I'm making a medical decision about

dosing and managing a high risk medication that will

certainly require an office visit. I don't recall one

complaint from a patient about coming into the office

for a PT in the last 10 years.

Most of these patients are Medicare age and their

share of the office visit is about $12 if they don't

have a secondary insurance. To them a personal visit

with the doctor is worth $12. Less than a virtual

visit.

Insulin and other diabetes meds are preferentially

managed at office visits as well. I have the

patient's labs drawn 2-3 days ahead and we sit down

and go over the results in person. I use the EMR to

catch up on their deferred health maintainance. These

are usual complex visits covering multiple issues.

I will on occasion adjust meds over the phone on

patients that have been in recently and just need a

minor tweak.

Are you paid on capitation or do you make a practice

of not getting paid appropriately for your time and

expertise?

Ben

--- Dr Levin <dr_levin@...

<mailto:dr_levin%40comcast.net> > wrote:

> You mean to tell me that you see a pt EVERY SINGLE

> TIME just to review a protime and adjust the

> coumadin?

>

> This means when a pt is discharged from the

> hospital, you'd see them, maybe, every 2-3 days for

> 3 weeks, then every 1 week, then every 2 weeks, then

> every 3-4 weeks, and BILL THEM FOR THAT VISIT?

>

> Hmmmmmmmm.........................

>

> How do you change diabetic medications for glucoses,

> or insulin dosages?

>

> Pardon my capitalization and cynicism, but I just

> don't get it...............

>

> Matt

> REimbursement

> for

> > managing anticoagulation

> >

> >

> > I have a number of pts on warfarin whom I am

> > managing. The time it

> > takes to review lab, review current dose,

> > adjust/record changes,

> > call/email patient with instructions is

> > significant x 12. Does anyone

> > know if there a way to be reimbursed for this?

> >

> >

> >

> >

>

>

>

__________________________________________________________

> Looking for last minute shopping deals?

> Find them fast with Yahoo! Search.

>

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping>

>

>

>

__________________________________________________________

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

Looking for last minute shopping deals? Find

them fast with Yahoo! Search.

[Guest guest]

Great discussion. Many variations on approach to management and reimbursements. So, if you dont test in the office and dont see the patient in the office, can you bill through virtual visit? What codes do you use for this?

Hi Don,I am interested in your INR machine.

Please reply offlist to abuice2002@...

>> I generally bring the patient in for a " paying " visit every 3 – 4 times I> review an INR. Most of these patients have lots of other problems, so> there is no need for " creative billing. " I simply tell the patient at the> beginning that I will have them get the blood drawn at the lab, with no> co-pay, for the majority of their blood draws, but that they will have to> schedule a " real " visit with me to review things every few months, or more> often if they are complicated. > > > > I do use the INRatio machine in the office, and it is a wash, so I only use> it during " real " visits, when we can discuss the results face-to-

face at the> time of service. It is a real convenience for me, however, to get the> results during the visit. My patients usually get their " no-copay " INR> drawn at a LabCorp draw station located at my previous office, and they do> get the results at the time of service. The results are faxed to me within> about an hour, and I review the faxes and email my instructions before I " go> home " in the afternoon. > > > > By the way, I happened to get two INRatio machines when I set up the office.> They were included in a bulk purchase deal when I got a year's worth of> Cholestech cassettes and a couple of Cholestech machines at a good price. I> would be happy to sell one brand spanking new-in-the-box INRatio machine to> an IMPer for $100.00 if anyone wants one. Remember, this is a> " break-even " test, and the media costs about $4.00 each, so you will not> possibly make money on the deal (unless you have patients you can convince> to come in for a " real visit " every time they need an INR. ) I think the> INRatio machines list at over $1,

000.00 new, so you could probably even sell> it on e-bay and make a profit, but I have enough on my plate without trying> to sell things on e-bay. The machines are quite accurate, and are not

> hard to use, though there is a learning curve to getting a big enough drop> of the patient's blood on just the right spot on the sensor. > > > > T. , MD> > Sammamish Diabetes and Lipid Clinic, PLLC> > In business since the last week in July, 2007. Finally got my Medicare> approval on December 31, just too late to change my status for the

next> year. > > > > From: > [mailto:

] On Behalf Of Dr Levin> Sent: Wednesday, January 02, 2008 4:55 PM> To:

> Subject: Re: REimbursement for managing> anticoagulation> > > > No -- there's a code but noone pays for it.> > Some docs use the machine in the office, but concensus is that it's a wash,> unless you bring pt in for each and every time.> > > > In my area, no patient would do this, and the local cardiology group did> this for awhile, then stopped it.

> > > > Now I'm ready for the argument from those here who see, adjust coumadin and> charge a visit for each of these.> > > > Matt in Western PA> > REimbursement for managing anticoagulation> > > > I have a number of pts on warfarin whom I am managing. The time it > takes to review lab, review current dose, adjust/record changes, > call/email patient with instructions is significant x 12. Does anyone > know if there a way to be reimbursed for this?>

[Guest guest]

How do you get medicare to pay you $24 for phlebotomy? They pay me $3

Annie

Re: Reimbursement for managing

anticoagulation

Matt,

I manage the majority of my Coumadin patients at the

point of care with a Clia waved Protime machine. We

are a rural office and the nearest hospital is 20

miles away so it really is the most convenient way for

us to operate. There are no call backs, no emails are

needed and the feedback is immediate.

I will see a new Coumadin patient as often as needed

to get them stable. Probably 2 times the first week

or two then weekly then q2weeks for a time or two,

then monthly. If I'm making a medical decision about

dosing and managing a high risk medication that will

certainly require an office visit. I don't recall one

complaint from a patient about coming into the office

for a PT in the last 10 years.

Most of these patients are Medicare age and their

share of the office visit is about $12 if they don't

have a secondary insurance. To them a personal visit

with the doctor is worth $12. Less than a virtual

visit.

Insulin and other diabetes meds are preferentially

managed at office visits as well. I have the

patient's labs drawn 2-3 days ahead and we sit down

and go over the results in person. I use the EMR to

catch up on their deferred health maintainance. These

are usual complex visits covering multiple issues.

I will on occasion adjust meds over the phone on

patients that have been in recently and just need a

minor tweak.

Are you paid on capitation or do you make a practice

of not getting paid appropriately for your time and

expertise?

Ben

--- Dr Levin <dr_levin@... <mailto:dr_levin%40comcast.net> > wrote:

> You mean to tell me that you see a pt EVERY SINGLE

> TIME just to review a protime and adjust the

> coumadin?

>

> This means when a pt is discharged from the

> hospital, you'd see them, maybe, every 2-3 days for

> 3 weeks, then every 1 week, then every 2 weeks, then

> every 3-4 weeks, and BILL THEM FOR THAT VISIT?

>

> Hmmmmmmmm.........................

>

> How do you change diabetic medications for glucoses,

> or insulin dosages?

>

> Pardon my capitalization and cynicism, but I just

> don't get it...............

>

> Matt

> REimbursement

> for

> > managing anticoagulation

> >

> >

> > I have a number of pts on warfarin whom I am

> > managing. The time it

> > takes to review lab, review current dose,

> > adjust/record changes,

> > call/email patient with instructions is

> > significant x 12. Does anyone

> > know if there a way to be reimbursed for this?

> >

> >

> >

> >

>

>

>

__________________________________________________________

> Looking for last minute shopping deals?

> Find them fast with Yahoo! Search.

>

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping>

>

>

>

__________________________________________________________

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

[Guest guest]

That is the fee for the code. As mentioned, I don't always bill it, since is

suppose to be for those who are tough draws. Many are?!

________________________________

From: on behalf of Annie Skaggs

Sent: Fri 1/4/2008 8:54 PM

To:

Subject: RE: Reimbursement for managing anticoagulation

How do you get medicare to pay you $24 for phlebotomy? They pay me $3

Annie

Re: Reimbursement for managing

anticoagulation

Matt,

I manage the majority of my Coumadin patients at the

point of care with a Clia waved Protime machine. We

are a rural office and the nearest hospital is 20

miles away so it really is the most convenient way for

us to operate. There are no call backs, no emails are

needed and the feedback is immediate.

I will see a new Coumadin patient as often as needed

to get them stable. Probably 2 times the first week

or two then weekly then q2weeks for a time or two,

then monthly. If I'm making a medical decision about

dosing and managing a high risk medication that will

certainly require an office visit. I don't recall one

complaint from a patient about coming into the office

for a PT in the last 10 years.

Most of these patients are Medicare age and their

share of the office visit is about $12 if they don't

have a secondary insurance. To them a personal visit

with the doctor is worth $12. Less than a virtual

visit.

Insulin and other diabetes meds are preferentially

managed at office visits as well. I have the

patient's labs drawn 2-3 days ahead and we sit down

and go over the results in person. I use the EMR to

catch up on their deferred health maintainance. These

are usual complex visits covering multiple issues.

I will on occasion adjust meds over the phone on

patients that have been in recently and just need a

minor tweak.

Are you paid on capitation or do you make a practice

of not getting paid appropriately for your time and

expertise?

Ben

--- Dr Levin <dr_levin@... <mailto:dr_levin%40comcast.net>

<mailto:dr_levin%40comcast.net> > wrote:

> You mean to tell me that you see a pt EVERY SINGLE

> TIME just to review a protime and adjust the

> coumadin?

>

> This means when a pt is discharged from the

> hospital, you'd see them, maybe, every 2-3 days for

> 3 weeks, then every 1 week, then every 2 weeks, then

> every 3-4 weeks, and BILL THEM FOR THAT VISIT?

>

> Hmmmmmmmm.........................

>

> How do you change diabetic medications for glucoses,

> or insulin dosages?

>

> Pardon my capitalization and cynicism, but I just

> don't get it...............

>

> Matt

> REimbursement

> for

> > managing anticoagulation

> >

> >

> > I have a number of pts on warfarin whom I am

> > managing. The time it

> > takes to review lab, review current dose,

> > adjust/record changes,

> > call/email patient with instructions is

> > significant x 12. Does anyone

> > know if there a way to be reimbursed for this?

> >

> >

> >

> >

>

>

>

__________________________________________________________

> Looking for last minute shopping deals?

> Find them fast with Yahoo! Search.

>

http://tools.search.yahoo.com/newsearch/category.php?category=shopping

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping>

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping

<http://tools.search.yahoo.com/newsearch/category.php?category=shopping> >

>

>

>

__________________________________________________________

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

<http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ> >