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Pre-Op PT/INR Denied

Jacoder

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I'm sorry if this is a duplicate thread. I searched the AAPC forum yesterday and couldn't find what I was looking for.

I work at a hospital. Recently my doctor ordered a PT/INR and PTT with the dx of "Pre-OP", nothing else. I knew this wouldn't cover it so I got the Dr to give me the surgury dx, which was Osteomyelitis of the toe. The patient is having her toe amputated. This still doesn't cover it according to Medicare. I talked to the doctor and he said that a surgan wouldn't touch a patient with out this test because they wouldn't know if the patient would bleed to death or not. It's necessary. So now I'm very frustraited because I can't find a way to get these paid and it seems like Medicare should cover this.

Does anyone have any advice on how to get PT/INR's paid for Pre-Op? Is an ABN the only solution? I'm to the point that I would almost try to appeal/ ask for a modification of medical necessity edits, but I don't think that is an option. If doctors are saying that this lab is absolutely necissary I just can't understand how Medicare can deny it. Thanks for your input.
 

mitchellde

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Is the patient on any anticoagulant drug? If so this is then a V58.83 with a V58.69, if they are not then you use the V72.8x code for preop.
 

Jacoder

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No, the patient is not on an antiocoagulation drug. I understand how to code it, the problem is that the CMS Local Coverage Determination Policy doesn't include the Dx V72.8X or V72.63. Even if I code it correctly, it will not be paid.
 

mitchellde

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Sad but true! I have not ever had a pre op PT/INR ordered unless there was a hx of a liver disorder or anti coag drugs. I know every surgeon does not order this. Is there any history of trauma? we had one patient that had a hx of serious trauma which required the surgeons to have a PT/INR before any surgery as the trauma damaged his liver and he had then a deficency I think they called it a factor 8 but I could be wrong it has been awhile. The patient never needed any meds for it he was just a high risk patient when it came to surgery. We use the late effect of trauma code to get that to work. Otherwise there is nothing else I can think of that would nessitate this test.
 

j-fowler57

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Does the pt. have venous insuff. or CHF, edema, any type of renal ? I know you have probably checked all of this but I also have had difficulty in getting payable dx's for these tests. And most of our drs. order it as well prior to surgery.
 

Jacoder

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I just found out that the patient has Coronary Artery Disease, but I'm afraid that would be coding only to get paid, because the CAD doesn't effect the bleeding so it is kind of unrelevent to surgery. I'm a little leary about using this dx.
 

Jacoder

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No, nothing. I think we're just going to have to eat this one. I guess the next step is to see what I need to do to get an ABN in place or if it is even worth it. Not for this patient account, but for future dates. Thanks for y'alls help!
 
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