Correct Billing of Test Materials and Equipment for Home International Normalized Ratio (INR) Monitoring and Physician Review

This article addresses the correct billing, service and documentation requirements for HCPCS codes G0249 and G0250.

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; testing not occurring more frequently than once a week; testing materials, billing units of service include four tests.

G0250: Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include four tests.

The correct billing of test materials and equipment for home INR monitoring and the reporting of the results to the physician (HCPCS code G0249) requires that sufficient internal controls exist at the provider to ensure documentation exists to support the full scope of services being billed. HCPCS code G0249 requires not only the provision of test materials and equipment to eligible beneficiaries, but also the reporting of test results to the physician. Testing is limited to once per week, and HCPCS code G0249 requires that four tests be performed and results reported to the physician in order to meet the service requirement. Health records lacking information regarding when and how the physician was notified would not meet the service requirement necessary to submit HCPCS code G0249.

As part of its ongoing effort to promote correct coding of Medicare-covered services, Palmetto GBA may conduct inspections/reviews of health records associated with claims containing HCPCS code G0249. Health records lacking sufficient information to substantiate the correct billing of HCPCS code G0249 will be viewed as non-conforming products of organization's billing processes. As organizations examine their quality management systems they are encouraged to inspect their documentation, prior to submitting the claim to ensure that all components required for billing HCPCS code G0249, is present.

For more information on non-conforming products and how to systematically address them, please see the Palmetto GBA article titled '
Reducing the Frequency of Medicare Payments and Denials for Claims with Insufficient Documentation.'

Physicians submitting claims for HCPCS code G0250 for the review, interpretation and patient management associated with covered INR testing should record the results of home INR testing and ensure that each of the four test results reviewed are documented in order to meet the HCPCS code G0250 service requirements. Doing so will promote correct coding and payment and decrease potential delays in reimbursement due to record reviews.

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