Posted on 26. Mar, 2009 by in Hot Coding Topics
Although you can’t use 85610 (Prothrombin time) for home PT monitoring, you can charge for certain associated services provided the patient meets Medicare’s new criteria.
Expand Your ‘Medical Necessity’ Know-How
Medicare has covered home PT/INR monitoring for anticoagulation management in mechanical heart valve patients since 2001.
More recently, CMS stated that Medicare will also cover patients on warfarin therapy who have chronic atrial fibrillation, venous thromboembolism (including deep venous thrombosis), or pulmonary embolism. CMS updated the list of covered ICD-9 codes for home PT/INR monitoring in Feb. 2009 (effective retroactively to March 19, 2008) to include the following:
• V43.3 — Organ or tissue replaced by other means; heart valve
• 289.81 — Primary hypercoagulable state
• 415.1x — Pulmonary embolism and infarction
• 427.31 — Atrial fibrillation
• 451.0-451.9 — Phlebitis and thrombophlebitis
• 453.0-453.3 — Other venous embolism and thrombosis
• 453.40-453.9 (includes 453.40-453.42, 453.8-453.9) — Venous embolism and thrombosis of deep vessels of lower extremity.
Count only mechanical valves. The expanded coverage doesn’t extend to PT/INR home monitoring for patients on warfarin following porcine heart valve replacement.
Delve Into the New Policy
To make sure the patient qualifies for the home PT/INR home monitoring based on CMS guidelines, use the following checklist:
• A physician prescribes the home monitoring
• Anticoagulation therapy has been in place for at least three months prior to implementing home monitoring
• Patient receives training in how to use the monitoring device
• Patient performs the test...
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