What can providers do to facilitate payment for home PT/INR monitoring and related services?
To ensure appropriate reimbursement, claims should be coded to accurately and fully report the procedures performed and the patient’s condition with the appropriate ICD-9 diagnosis code. Documentation in the patient records should accurately reflect the services provided to patients. If a question arises, the physician may need to prepare and send a letter of medical necessity to the insurer. Two of the most common reasons that claims are denied are: • ICD-9-CM code was not included on the claim form. • The claim form was not completely filled out – some elements were missing. Q: Does the physician need to see the patient face-to-face to bill “G0250 physician review; interpretation and patient management?” A: No. Face-to-face service is not required. Physicians may consult with patients by telephone.
