AMA CPT® Assistant - 2017 Issue 3 (March)
Evaluation and Management: Case Management Services (Q&A) (March 2017)
March 2017 page 10 Evaluation and Management: Case Management Services Question: Is it appropriate to report Current Procedural Terminology (CPT®) code 99363 for anticoagulant management, initial 90 days of therapy if the patient is admitted after those 90 days of therapy? Answer: It is appropriate to report code 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) in this scenario for the initial 90 days...
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Article Overview
This article explains a case management services coding question in the Evaluation and Management area, focusing on outpatient anticoagulant management and how the timing of hospital admission or discharge affects reporting. It is intended for coders, billers, and reimbursement staff who work with CPT-based evaluation and management guidance. The piece discusses the general circumstances for reporting ongoing outpatient anticoagulation management, the distinction between continuous therapy periods and shorter final periods, and notes that payer policies may differ from CPT guidance.
Why This Topic Matters
It helps readers understand when this category of case management service is treated as outpatient-only guidance and how hospitalization can affect the reporting period. That makes it relevant for accurate CPT-based E/M documentation review and claims preparation.
Article Sections
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March 2017 page 10
Publication and page identification for the Q&A content.
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Evaluation and Management: Case Management Services
A coding question and answer discussion about outpatient anticoagulant management services and how timing affects reporting across care settings.
What You Will Learn
- How this Q&A frames outpatient case management services within evaluation and management guidance.
- How hospitalization and post-hospital care can affect the reporting context for anticoagulation management.
- How short-duration follow-up anticoagulant management is addressed in relation to office or outpatient encounter reporting.
- That third-party payer policies may differ from CPT guidance.
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Revenue cycle professionals
- Physician practice administrators
Codes Discussed
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