The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism inclusive of deep venous thrombosis and pulmonary embolism on warfarin.
The patient has been anticoagulated for at least three months prior to use of the home INR device and he/she undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home.
The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following initiation of home monitoring and home-testing with the device occurs no more frequently than once a week
Managing Anti-Coagulation
There are at least three strategies for managing warfarin anticoagulation,
- Physician office-based testing and management
- Anticoagulation clinics
- Home PT/INR monitoring with patient reporting or physician-directed self-management.
Most patients being anticoagulated are managed through physician offices, the "usual care" approach.
Individual physicians manage their patients and PT/INR test frequency is generally once every 4-6 weeks.
The physician's service is billed with procedure code G0250, no more frequently than once every 4 weeks or every 28 days (7 days/week x 4 = 28 days). There must be 28 days between each submission of G0250.
Clinical Example
- Patient tests 4 times, on Fridays, in April of 2021
- The patient tested on April 2, 9, 16, and 23
- Physician bills G0250 on April 23,2021
- A physician can only bill G0250 once every 4 weeks (28 days)
Covered ICD Codes
- I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
- I26.94 Multiple subsegmental pulmonary embolism without acute cor pulmonale
- I48.0 Paroxysmal atrial fibrillation
- I48.11 Longstanding persistent atrial fibrillation
- I48.19 Other persistent atrial fibrillation
- I48.20 Chronic atrial fibrillation, unspecified
- I48.21 Permanent atrial fibrillation
- I48.3 Typical atrial flutter
- I48.4 Atypical atrial flutter
- I48.91 Unspecified atrial fibrillation
- I48.92 Unspecified atrial flutter
- I49.02 Ventricular flutter
- O88.211 Thromboembolism in pregnancy, first trimester
- O88.212 Thromboembolism in pregnancy, second trimester
- O88.213 Thromboembolism in pregnancy, third trimester
- O88.219 Thromboembolism in pregnancy, unspecified trimester
- O88.22 Thromboembolism in childbirth
- O88.23 Thromboembolism in the puerperium
- T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
- T82.02XA Displacement of heart valve prosthesis, initial encounter
- T82.03XA Leakage of heart valve prosthesis, initial encounter
- T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
- T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
- T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
- T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
- T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
- T82.120A Displacement of cardiac electrode, initial encounter
- T82.121A Displacement of cardiac pulse generator (battery), initial encounter
- T82.128A Displacement of other cardiac electronic device, initial encounter
- T82.129A Displacement of unspecified cardiac electronic device, initial encounter
- T82.190A Other mechanical complication of cardiac electrode, initial encounter
- T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
- T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
- T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
- Z95.2 Presence of prosthetic heart valve
- Z95.3 Presence of xenogenic heart valve
- Z95.4 Presence of other heart-valve replacement
- Z95.5 Presence of coronary angioplasty implant and graft
- Z95.810 Presence of automatic (implantable) cardiac defibrillator
- Z95.811 Presence of heart assist device
- Z95.818 Presence of other cardiac implants and grafts
- Z95.9 Presence of cardiac and vascular implant and graft, unspecified
Tips
- Self-testing with the device is limited to a frequency of once per week.
- Testing more frequently than once per week is generally considered not medically necessary.
- Billing units of service include 4 tests
- The date of service should be considered as - End date of the final test.
PT/INR - Home Monitoring Codes are, G0248, G0249 & G0250,
- G0248 - The provider demonstrates the use and care of an INR monitor,
- G0249 - For home INR monitoring supplies,
- G0250 - Physician review, interpretation, and patient management of home INR testing for patient
Note:
The billing of CPT code G0250 is subject to a 28-day rule. This means that the physician cannot submit a claim for G0250 earlier than 28 days from the date of the last bill for the same service for the same patient.
There must be 28 full days between each submission date. If G0250 is submitted within 28 days, the claim will be denied.
