Cardiology Coding Alert

Question: Can you please explain the time limit for G0250? We have experienced some recent denials with this code and aren't sure why.

Hawaii Subscriber

Answer: Not meeting the time limit for 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) is a fairly common reason that Medicare denies claims for this code.

Rule: Cardiologists should only bill G0250 once every four weeks (28 days). So, if the cardiologist submits G0250 before the 28 full days have passed, Medicare will deny your claim.

Many physicians want their patients to perform the test more frequently than once per week when the test result isn't optimal (too high or low), says Ray Cathey, PA, FAAPA, MHS, MHA, CCS-P, CMSCS, CHCI, CHCC, president of Medical Management Dimensions in Stockton, California.

"The provider then wants to bill for more than four tests, because the understanding is that the G0250 is 'per four tests,' but they don't understand the caveat that the test is once per week, so after completing four tests in two weeks, the provider bills G0250 and adjusts the warfarin dosage," Cathey says. "Then after four more tests in two weeks, the provider again bills G0250."

While the frequency of the testing is not disputed, the code states "... not occurring more frequently than once a week," according to Cathey.

Medicare doesn't dispute the necessity for more frequent testing. But the code description and Medicare's policy indicate that CMS won't approve more than four tests per 28 days, so billing should not occur sooner than 29 days apart, Cathey says.