Billing Prothrombin Time (PT): Medicare Part A

Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Prothrombin Time (PT). The PT must meet medical necessity criteria, even when done as part of a coagulation clinic or “incident to” other services.
Medicare pays for services based on medical necessity. These tests must be:

  • Consistent with symptoms or diagnosis of the illness or injury under treatment,
  • Necessary and consistent with generally accepted medical standards, and
  • Furnished at the most appropriate level which can be provided safely and effectively to the patient.

Documentation in the medical record must support the PT was completed and was necessary. Providers are also reminded that a physician/non physician practitioner (NPP) signed and dated order or intent to order the test must be present in the patient’s records.

Note: Standing orders or protocol requesting a PT for a certain group of patients does not meet medical necessity criteria.

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INDUSTRY NEWS TAGS: Noridian Administrative Services

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