Pathology/Lab Coding Alert

This checklist reveals if patient qualifies for using three G codes. 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- [...]