The prothrombin time (PT) test is an in-vitro test to assess coagulation. PT testing and its normalized correlate, the International Normalized Ratio (INR), are the standard measurements for therapeutic effectiveness of warfarin therapy. Warfarin, Coumadin®, and others, are self-administered, oral anticoagulant, or blood thinner, medications that affect a person’s Vitamin K-dependent clotting factors.
Use of the INR allows physicians to determine the level of anticoagulation in a patient independent of the laboratory reagents used. The INR is the ratio of the patient’s prothrombin time compared to the mean prothrombin time for a group of normal individuals.
Coverage Requirements
For services furnished on or after July 1, 2002, Medicare will cover the use of home INR monitoring for anticoagulation management for patients with mechanical heart valves on warfarin. The monitor and the home testing must be prescribed by a physician and the following patient requirements must be met:
• Must have been anticoagulated for at least 3 months prior to use of the home INR device;
• Must undergo an educational program on anticoagulation management and the use of the device prior to its use in the home; and
• Self testing with the device is limited to a frequency of once per week.
Allowable Covered Diagnosis Codes
For services furnished on or after July 1, 2002, the applicable ICD-9-CM diagnosis code for this benefit is V43.3, organ or tissue replaced by other means; heart valve.
For services furnished on or after March 19, 2008, the applicable ICD-9-CM diagnosis codes for this benefit are:
V43.3 (organ or tissue replaced by other means; heart valve),
289.81 (primary hypercoagulable state),
451.0-451.9 (includes 451.11, 451.19, 451.2, 451.80-451.84, 451.89) (phlebitis & thrombophlebitis),
453.0-453.3 (other venous embolism & thrombosis),
453.40-453.49 (includes 453.40-453.42, 453.8-453.9) (venous embolism and thrombosis of the deep vessels of the lower extremity, and other specified veins/unspecified sites)
415.11-415.12, 415.19 (pulmonary embolism & infarction) or,
427.31 (atrial fibrillation (established) (paroxysmal)).
Healthcare Common Procedure Coding System (HCPCS) for Intermediaries
G0248: Demonstration, prior to initial use, of home INR monitoring for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient ability to perform testing prior to its use
Short Description: Demonstrate use home INR mon
G0249: Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting of test results to physician; not occurring more frequently than once a week
Short Description: Provide INR test mater/equip
