Do you get charged?

[Lisa in Katy]

Bugsy, I just checked and the CPT code for reviewing protimes (INR) is 99363 or 99364. For my company, that is a zero pay code, meaning we don't pay the physician and he can't bill you either. It is considered bundled into the evaluation and management services that he bills for when you have your annual visit. I would bet most large insurance companies treat this code the same way since this is the Medicare policy and we all generally follow those policies.

If your insurance company is one of the odd ones that allows it (which I doubt since they are not paying for it), your doctor is supposed to only be billing you once every 90 days and it includes a minimum of 3 tests.

My guess is that your physician's office is billing you fraudulently, perhaps on purpose, perhaps because they don't know any better.

 

[Lisa in Katy]

"Medicare" that is the deal. Several months ago, my coumadin clinic wanted me to start testing on a weekly basis, under the guise that home testers are much safer by testing weekly, and calling my INR results into QAS, who then would fax results to the clinic. The clinic in turn wanted to make money off of us home testers so they then bill Medicare for 'managing' my INR.

The catch here is I'm not on Medicare, that won't be for some time, and I told them I was not about to purchase more strips, pay out of pocket for them and wait for my insurance to reimburse me, test weekly, and use a third party when I can fax my results just the same as QAS. I already test bi-weekly and order all my strips at one time for the year based on this testing schedule.

After discussions with the head nurse that runs the clinic, she admitted that they were trying to recoup expense on home testers by billing medicare for services and reducing the call ins. She also relented that she did not want to inconvenience me, cause me more strip expense, and that I could call in my results as I had before. So, I still test bi-weekly and call in my results monthly. I've had stable INRs for quite some time, the only time I will need to call more frequently is if my INR gets out of whack.

It's a money making business no matter what.

Unless they have changed their policy in the last few months, Medicare doesn't pay for managing anticoagulation.

 

[Guest]

Unless they have changed their policy in the last few months, Medicare doesn't pay for managing anticoagulation.

Medicare may not but the coumadin clinic bills medicare for the service somehow, it's not much according to the nurse, maybe they use a certain ICD9 code.

 

[Lisa in Katy]

Sounds like part of the fraud and abuse that is supposed to pay for health care reform! The correct CPT code is not a payable code.

 

[Bugsy]

Thank you all for your help. Lisa, the Charge Code on my bill is G0250 but that could be an internal code from the cardiologist's office. I'm not really sure how to proceed with this but I have my annual echo scheduled for Monday. I'm thinking about cancelling it until I find a new cardiologist. I'm sure they make a pretty good profit from that and I would rather my new Doc get it. BTW I sent you a PM Lisa.

 

[Lisa in Katy]

I'm learning something new here. This is not actually a new code, but was updated recently to reflect an expansion in coverage. In the past, it was only payable if it involved a face to face meeting with the physician to verify that you were using the machine correctly. Now Medicare pays $9.08, whether or not the face to face takes place. I'm not sure why they treat you calling in a number differently than if they got the number from the lab.

As you can see from the following description, it is supposed to cover 4 tests, no more than one a week, so if they are billing it every test, they are doing it wrong.

"G0250 Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests - Last Update 8/16/2009"

BTW, this is still a zero pay code for my employer, and the member is not expected to pay for it either. When Medicare makes updates, private insurance companies often adopt them, but it sometimes takes a while. In this case, I'm not sure private insurance companies will adopt the change because again, why should this be different than if a lab does the test?

 

[Bugsy]

I tried QAS but they couldn't help me. I also called my cardiologist's office and cancelled my echo scheduled for Monday and left a message with their billing department to give me a call. I'm looking for a new doc but it seems like they're all part of a network and it's very difficult to talk to someone who can give me straight answers.

 

[Bridgette]

Hi Bugsy - sorry that you are going through all these hassles!

My solution: come and live in NZ, where, under our "socialised health system" you can home test, call your results in to your GP if you wish, and they will advise you of your dose adjustments (if necessary), and not charge you a thing!
Or you can do your own dose adjustments, ie self manage, with your doctors approval. My GP is fine about me doing that, although there is ONE bolshy nurse in his practice who thinks that patients are incapable of self management. Last week she called me on my cellphone while I was at work, saying that my doctor wanted me to go for a lab test.
"But he knows I self test, and manage my dosage myself" I said.

"Oh no, he doesn't, he's very concerned that you haven't had an INR test for over a year" she replies.

WTF? I went home after work and emailed him, and what she said was crap, because he emailed back saying yeah, you're fine, carry on with what you're doing.
So she made up that little story!

Anyway, good luck on finding an answer to your problem.

Bridgette

 

[geebee]

My solution: come and live in NZ, where, under our "socialised health system" you can home test, call your results in to your GP if you wish, and they will advise you of your dose adjustments (if necessary), and not charge you a thing!

Really, no taxes for healthcare or nothing? Sounds like a perfect place to live.

 

[Bridgette]

Oh yeah, of course taxes for healthcare, but I don't mind paying them

 

[geebee]

Oh yeah, of course taxes for healthcare, but I don't mind paying them

Kind of curious - what rate or amount is charged?

 

[olefin]

"Medicare" that is the deal. Several months ago, my coumadin clinic wanted me to start testing on a weekly basis, under the guise that home testers are much safer by testing weekly, and calling my INR results into QAS, who then would fax results to the clinic. The clinic in turn wanted to make money off of us home testers so they then bill Medicare for 'managing' my INR.
The catch here is I'm not on Medicare, that won't be for some time,

It's my understanding, coming from my Cardiologist's office, that he gets no pay from Medicare unless his office does the test. I believe that to be fact... for I get a copy of all charges from the doctor that Medicare and my insurance pays. And in the last few months I've seen no charges since home testing. Except back at first when he wanted a monthly test. He no longer requires me to test at his office.

 

[Guest]

Now Medicare pays $9.08, whether or not the face to face takes place.

"G0250 Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests - Last Update 8/16/2009"

Lisa, thanks for finding this information, I bet this is what the nurse was explaining to me. She said the payment was a small amount.

 

[olefin]

Originally Posted by Lisa in Katy View Post
Now Medicare pays $9.08, whether or not the face to face takes place.

"G0250 Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests - Last Update 8/16/2009"

Then my Cardiologist must not know he can get pay? His wife takes care of insurance and she was the one that told me he didn't get pay unless he did the test. He was only getting $20 when he did the the monthly test and he was paying a lab to run it. She needs to read GO250.