Cardiology Coding Alert

Don't miss: Counseling services can sometimes mean an E/M codePatients using warfarin (brand name Coumadin) for chronic atrial fibrillation and venous thromboembolism can rejoice. CMS opened the door to new payment rules governing prothombin time testing, and this time, the new rules expand coverage, rather than restrict it.In the past: Before this revision to Medicare's National Coverage Determination (NCD), Medicare allowed home testing coverage only for beneficiaries with mechanical heart valves who took warfarin.The agency instructed carriers to implement the new policy by Aug. 25 in Transmittals 90 and 1562, both dated July 25.Delve Into the New PolicyUnder the new policy, "the patient would have to first be anticoagulated for three months or longer before implementing home monitoring," says Nicole Smith, CPC-CARDIO, E/M, a coder at Spokane Cardiology in Wash. "Education has to be provided to the patient about how to use the monitoring device, and home testing shouldn't be done more than once a week," she says.Keep in mind: You can collect for the patient education session when teaching the patient how to use the home monitoring device. "The 2008 HCPCS Level II manual describes these services in depth," says Christina Neighbors, MA, CPC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. Those codes are as follows:• 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 documentation of patient ability to perform testing (Initial service/charge)• 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 (Additional service/charge per four tests)• G0250 -- Physician review, interpretation and patient management of home INR testing for patient with mechanical heart valve(s) who meets other coverage criteria; per four tests (does not require face-to-face service).You'll find a new list of diagnosis codes that constitute medical necessity. Accepted ICD-9 codes include:
 • 289.81 -- Primary hypercoagulable state
 • 415.11-415.19 -- Pulmonary embolism and infarction
 • 427.31 -- Atrial fibrilation, established, paroxysmal
 • 451.0-451.9 -- Phlebitis and thrombophlebitis
 • 453.0-453.3 -- Other venous embolism and thrombosis
 • V43.3  -- Organ or tissue replaced by other means; heart valve.Check Your Location and Additional ServicesIn some cases, the patient may present to the practice for testing rather than perform the test at home, which you should code differently.Many physician offices have a designated area called a "Coumadin clinic" where the nurse can assess the patient's clotting time using [...]