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Cardiology Coding Alert

READER QUESTIONS:

Add Dx to Your Home PT/INR Testing Options

Published on Sat Jan 03, 2009

Question: I need to report home prothrombin time testing for a patient with femoral venous embolism and thrombosis (453.41). Why doesn't Medicare cover this?

Texas Subscriber

Answer: Good news -- Medicare recently announced that it will add 453.41 (Venous embolism and thrombosis of deep vessels of proximal lower extremity) and a few other diagnoses to the covered list.

The details: Change Request (CR) 6313 corrects CR 6138, "Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management," by adding ICD-9 codes that CR 6138 omitted:

• 451.11 -- Phlebitis and thrombophlebitis; of deep vessels of lower extremities; femoral vein (deep) (superficial)

• 451.19 -- ... other (includes femoropopliteal,popliteal, and tibial vein)

• 451.2 -- ... of lower extremities, unspecified

• 451.80-451.89 -- ... of other sites

• 453.40-453.42 -- Venous embolism and thrombosis of deep vessels of lower extremity

• 415.12 -- Pulmonary embolism and infarction; septic pulmonary embolism.

Reminder: Under the policy, the patient has to first be anticoagulated for three months or longer before implementing home monitoring. You must provide education about using the monitoring device, and home testing shouldn't be done more than once a week.

The relevant HCPCS codes for 2009 are as follows:

• G0248 -- Demonstration, prior to initial use, of home INR monitoring for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of 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 prior to its use

• 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 a patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes faceto- face verification by the physician that the patient uses the device in the context of the management of the anticoagulation therapy following initiation of the home INR monitoring; not occurring more frequently than once a week.

Resources: You can learn more reading MLN Matters article 6313 (www.cms.hhs.gov/MLNMattersArticles/downloads/MM6313.pdf) or CR 6313 (www.cms.hhs.gov/Transmittals/downloads/R1663CP.pdf).

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