Diagnosis Codes Added to PT/INR Coverage

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In CMS
February 13, 2009
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The Centers for Medicare & Medicaid Services (CMS) released, Jan. 8, Change Request (CR) 6313 to correct an error in a previous transmittal. Several ICD-9-CM codes that qualify for coverage of Prothrombin Time/International Normalized Ratio (PT/INR) monitoring for home anticoagulation management were inadvertently omitted in CR 6318.

CR 6318 established that, effective for claims with dates of service on and after March 19, 2008, Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin.

CR 6313 adds the following ICD-9-CM codes that were omitted in CR 6318:

425.12 Pulmonary embolism and infarction: septic pulmonary embolism

451.11 Phlebitis and thrombophlebitis: of deep vessels of lower extremities: femoral vein (deep) (superficial)

451.19 Phlebitis and thrombophlebitis: of deep vessels of lower extremities: other (femoropopliteal vein popliteal vein tibial vein)

451.2 Phlebitis and thrombophlebitis: of deep vessels of lower extremities: other (femoropopliteal vein, popliteal vein, tibial vein)

451.80 Phlebitis and thrombophlebitis: of other sites

451.81 Phlebitis and thrombophlebitis: of other sites: iliac vein

451.82 Phlebitis and thrombophlebitis: of other sites: of superficial veins of upper extremities (anticubital vein, basilic vein, cephalic vein)

451.83 Phlebitis and thrombophlebitis: of other sites: of deep veins of upper extremities (brachial vein, radial vein, ulnar vein)

451.84 Phlebitis and thrombophlebitis: of other sites: of upper extremities, unspecified

451.89 Phlebitis and thrombophlebitis: of other sites: other

453.40 Venous embolism and thrombosis of deep vessels of lower extremity: venous embolism and thrombosis of unspecified vessels of lower extremity (deep vein thrombosis NOS, DVT NOS)

453.41 Venous embolism and thrombosis of deep vessels of lower extremity: venous embolism and thrombosis of deep vessels of proximal lower extremity (femoral, iliac, popliteal; thigh, upper leg NOS)

453.42 Venous embolism and thrombosis of deep vessels of lower extremity: venous embolism and thrombosis of deep vessels of distal lower extremity (calf, lower leg NOS; peroneal, tibial)

453.48 Venous embolism and thrombosis of deep vessels of lower extremity: of other specified veins

453.49 Venous embolism and thrombosis of deep vessels of lower extremity: of unspecified site

Read MLN Matters article MM6313 for background information and a complete listing of ICD-9-CM codes Medicare coverage includes for PT/INR.

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