I have a question regarding Coumadin therapy. We have patients that come into our clinic that are being referred for Protimes and Partial Thromboplastin Times. These patients are being referred by the orthopedist. They are coming in to find out what their initial INR is to be put on Coumadin previous to orthopedic surgery (example: hip replacement). They have no other reason to have this test.

How should this be coded? Should it be coded by using V58.53 and V58.61, because they are going to be put on Coumadin and a level is needed before they can do so. Or should it be coded as a screening DX V72.84 for pre-operative knowledge. This is a issue because as you know Medicare does not cover for pre-op screening codes and the patient will be responsible.