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Pathology/Lab Coding Alert

Reader questions:

Limit Warfarin Responsiveness Test to Trial

Published on Fri Aug 13, 2010

Question: Our lab is performing a genetic test for warfarin responsiveness for certain patients as part of a clinical trial -- how should we code the service?Wisconsin SubscriberAnswer: You should report G9143 (Warfarin responsiveness testing by genetic technique using any method, any number of specimen[s]). The test looks for genetic markers to predict the body's  response to warfarin. It is a new type of analysis called "pharmacogenomics testing."Limitations: Medicare covers pharmacogenomic testing to predict warfarin responsiveness only "in the context of a prospective randomized, controlled clinical study when that study meets certain criteria as outlined in the Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 90.1," according to MLN Matters article MM6715 (revised). According to the article, testing is covered if the beneficiary meets three conditions:1. Is a candidate for anticoagulation therapy with warfarin 2. Has not been previously tested for CYP2C9 or VKORC1 alleles (the alleles warfarin responsiveness is limited [...]
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