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Cardiology Coding Alert

New Codes Allow Reimbursement For Home Coumadin Tests

Published on Tue Apr 01, 2003

Beginning in 2003, cardiology practices are able to monitor mechanical heart valve patients on blood thinner Coumadin, or warfarin sodium, from home. (For coding instructions on in-office Coumadin monitoring, see the March 2003 Cardiology Coding Alert article "Keep Reimbursement Flowing With a Coumadin Coding Checkup.")

To ensure proper payment, you should report the following new G codes for at-home Coumadin monitoring, as appropriate, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C., and compliance manager for Mid Carolina Cardiology in Charlotte, N.C. Remember that, in general, only Medicare accepts G codes, so you should consult with private payers before billing these codes.

  • G0248 Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve[s] who meets Medicare coverage criteria, under the direction of a physician; includes: demonstrating use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and demonstration of patient ability to perform testing.

    Bill G0248 when the patient has had training on self-testing. You can report this code only once in a patient's lifetime, Collins says.

  • G0249 Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve[s] who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting of test results to physician; per four tests.

    Report G0249 for the materials and equipment the patient will use for in-home monitoring, Collins says. This code covers materials for four tests and cannot be billed more frequently than once every four weeks, he adds.

  • G0250 Physician review, interpretation and patient management of home INR testing for a patient with mechanical heart valve(s) who meets other coverage criteria; per four tests (does not require face-to-face service).

    You should report G0250 when the physician reviews results and for any management the patient might need, Collins says. As with G0249, you cannot bill G0250 more frequently than once every four weeks.

    Before billing these codes, check your local medical review policy for specific guidelines, Collins says.

     

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