Wiki Medicare Denials G0250 / Anti-Coagulant Visits

[foxsd]

We are billing G0250 with dx I82.503, Z79.01 to Medicare for 4 units, once every 28/29 days. It comes back denied for every patient with denial reasons: C0151 (adjusted-number of services not supported); M25 (info provided doesn't substantiate need/svc) & N38 (Decision based on NCD).

Should the billing coordinators list Z79.01 primary? Do you have any experience or advise for this?

Thanks,

Sabrina Fox, CPC, CCA

 

[dferree37]

G0250

This is the information I found. It appears this should only be billed 1 unit per month.

The code covers the review and interpretation of the results of home international normalized ratio, or INR, monitoring in patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism. The code includes the review of results for four tests.

 

[thomas7331]

Agreed, the HCPCS code G0250 covers four weekly tests so should only be billed with one unit per month - I think that's likely your problem. The diagnosis code sequence should not create an issue, and a non-covered diagnosis would give you a different denial message.

 

[ghiles]

G0250 Minimum visits

Does Mcr require minimum of 4 test per month to bill?

 

[foxsd]

Does Mcr require minimum of 4 test per month to bill?

The patient can test UP TO 4 tests per month.

 

[Rachel5894]

G0250 billing DOS

Hello,
Our office bills as the DOS of when the interpretation and report was done. So say the last at home INR test from the pt was done on 3/21 but the documentation wasn't done until 3/28, this would be the DOS as when G0250 was billed. Also, some patients don't test once per week, sometimes its just once or twice a month. I am not finding any documentation to state that if its testing less than 4 times a month, cannot bill. Anyone have any guidance