(Medicare Claims Processing Manual)

 Critical Access Hospital (CAH) -  Reasonable cost or Medicare Physician Fee Schedule (MPFS)   Deductible and coinsurance apply.   60.3  Intermediary Billing Procedures  (Rev. 216, 06- 25-04)  60.3.1  Bill Types (Rev. 216, 06- 25-04)  The applicable bill types are 13X and 85X.   60.3.2  Revenue Codes (Rev. 216, 06- 25-04)  Hospitals may report these services under revenue code 920 or they may report HCPCS codes G0248 and G0249 under the revenue center where they are performed.   60.4  Intermediary Allowable Codes (Rev. 216, 06- 25-04)  60.4.1  Allowable Covered Diagnosis Codes  (Rev.10881; Issued: 08- 06-2021; Effective: 09- 07-2021; Implementation: 09- 07- 2021)   For services furnished on or after the implementation of ICD -10 the applicable ICD -10-CM diagnosis codes for this benefit are:    ICD-10-CM Code  Code Description  D68.51  Activated protein C resistance  D68.52  Prothrombin gene mutation  D68.59  Other primary thrombophilia  D68.61  Antiphospholipid syndrome  D68.62  Lupus anticoagulant syndrome  I23.6  Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction  I26.01  Septic pulmonary embolism with acute cor pulmonale  I26.09  Other pulmonary embolism with acute cor pulmonale  I26.90  Septic pulmonary embolism without acute cor pulmonale  I26.93  Single subsegmental pulmonary embolism without acute cor pulmonale  I26.94  Multiple subsegmental pulmonary emboli without acute cor pulmonale  I26.99  Other pulmonary embolism without acute cor pulmonale  I27.24  Chronic thromboembolic pulmonary hypertension  I27.82  Chronic pulmonary embolism  I48.0  Paroxysmal atrial fibrillation  I48.11  Longstanding persistent atrial fibrillation  I48.19  Other persistent atrial fibrillation  I48.21  Permanent atrial fibrillation  I67.6  Nonpyogenic thrombosis of intracranial venous system  I80.11  Phlebitis and thrombophlebitis of right femoral vein  I80.12  Phlebitis and thrombophlebitis of left femoral vein  I80.13  Phlebitis and thrombophlebitis of femoral vein, bilateral  I80.211  Phlebitis and thrombophlebitis of right iliac vein  I80.212  Phlebitis and thrombophlebitis of left iliac vein  I80.213  Phlebitis and thrombophlebitis of iliac vein, bilateral  I80.221  Phlebitis and thrombophlebitis of right popliteal vein  I80.222  Phlebitis and thrombophlebitis of left popliteal vein  I80.223  Phlebitis and thrombophlebitis of popliteal vein, bilateral  I80.231  Phlebitis and thrombophlebitis of right tibial vein  I80.232  Phlebitis and thrombophlebitis of left tibial vein  I80.233  Phlebitis and thrombophlebitis of tibial vein, bilateral  I80.241  Phlebitis and thrombophlebitis of right peroneal vein  I80.242  Phlebitis and thrombophlebitis of left peroneal vein  I80.243  Phlebitis and thrombophlebitis of peroneal vein, bilateral  I80.251  Phlebitis and thrombophlebitis of right calf muscular vein  I80.252  Phlebitis and thrombophlebitis of left calf muscular vein  I80.253  Phlebitis and thrombophlebitis of calf muscular vein, bilateral  I80.291  Phlebitis and thrombophlebitis of other deep vessels of right lower extremity  I80.292  Phlebitis and thrombophlebitis of other deep vessels of left lower extremity  I80.293  Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral  I82.0  Budd -Chiari syndrome  I82.210  Acute embolism and thrombosis of superior vena cava  I82.211  Chronic embolism and thrombosis of superior vena cava  I82.220  Acute embolism and thrombosis of inferior vena cava  I82.221  Chronic embolism and thrombosis of inferior vena cava  I82.290  Acute embolism and thrombosis of other thoracic veins  I82.291  Chronic embolism and thrombosis of other thoracic veins  I82.3  Embolism and thrombosis of renal vein  I82.411  Acute embolism and thrombosis of right femoral vein  I82.412  Acute embolism and thrombosis of left femoral vein  I82.413  Acute embolism and thrombosis of femoral vein, bilateral  I82.421  Acute embolism and thrombosis of right iliac vein  I82.422  Acute embolism and thrombosis of left iliac vein  I82.423  Acute embolism and thrombosis of iliac vein, bilateral  I82.431  Acute embolism and thrombosis of right popliteal vein  I82.432  Acute embolism and thrombosis of left popliteal vein  I82.433  Acute embolism and thrombosis of popliteal vein, bilateral  I82.441  Acute embolism and thrombosis of right tibial vein  I82.442  Acute embolism and thrombosis of left tibial vein  I82.443  Acute embolism and thrombosis of tibial vein, bilateral  I82.451  Acute embolism and thrombosis of right peroneal vein  I82.452  Acute embolism and thrombosis of left peroneal vein  I82.453  Acute embolism and thrombosis of peroneal vein, bilateral  I82.461  Acute embolism and thrombosis of right calf muscular vein  I82.462  Acute embolism and thrombosis of left calf muscular vein  I82.463  Acute embolism and thrombosis of calf muscular vein, bilateral  I82.491  Acute embolism and thrombosis of other specified deep vein of right lower extremity  I82.492  Acute embolism and thrombosis of other specified deep vein of left lower extremity  I82.493  Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral  I82.511  Chronic embolism and thrombosis of right femoral vein  I82.512  Chronic embolism and thrombosis of left femoral vein  I82.513  Chronic embolism and thrombosis of femoral vein, bilateral  I82.521  Chronic embolism and thrombosis of right iliac vein  I82.522  Chronic embolism and thrombosis of left iliac vein  I82.523  Chronic embolism and thrombosis of iliac vein, bilateral  I82.531  Chronic embolism and thrombosis of right popliteal vein  I82.532  Chronic embolism and thrombosis of left popliteal vein  I82.533  Chronic embolism and thrombosis of popliteal vein, bilateral  I82.541  Chronic embolism and thrombosis of right tibial vein  I82.542  Chronic embolism and thrombosis of left tibial vein  I82.543  Chronic embolism and thrombosis of tibial vein, bilateral  I82.551  Chronic embolism and thrombosis of right peroneal vein  I82.552  Chronic embolism and thrombosis of left peroneal vein  I82.553  Chronic embolism and thrombosis of peroneal vein, bilateral  I82.561  Chronic embolism and thrombosis of right calf muscular vein  I82.562  Chronic embolism and thrombosis of left calf muscular vein  I82.563  Chronic embolism and thrombosis of calf muscular vein, bilateral  I82.591  Chronic embolism and thrombosis of other specified deep vein of right lower extremity  I82.592  Chronic embolism and thrombosis of other specified deep vein of left lower extremity  I82.593  Chronic embolism and thrombosis of other specified deep vein of lower extremity, bilateral  I82.621  Acute embolism and thrombosis of deep veins of right upper extremity  I82.622  Acute embolism and thrombosis of deep veins of left upper extremity  I82.623  Acute embolism and thrombosis of deep veins of upper extremity, bilateral  I82.721  Chronic embolism and thrombosis of deep veins of right upper extremity  I82.722  Chronic embolism and thrombosis of deep veins of left upper extremity  I82.723  Chronic embolism and thrombosis of deep veins of upper extremity, bilateral  I82.890  Acute embolism and thrombosis of other specified veins  I82.891  Chronic embolism and thrombosis of other specified veins  I82.A11  Acute embolism and thrombosis of right axillary vein  I82.A12  Acute embolism and thrombosis of left axillary vein  I82.A13  Acute embolism and thrombosis of axillary vein, bilateral  I82.A21  Chronic embolism and thrombosis of right axillary vein  I82.A22  Chronic embolism and thrombosis of left axillary vein  I82.A23  Chronic embolism and thrombosis of axillary vein, bilateral  I82.B11  Acute embolism and thrombosis of right subclavian vein  I82.B12  Acute embolism and thrombosis of left subclavian vein  I82.B13  Acute embolism and thrombosis of subclavian vein, bilateral  I82.B21  Chronic embolism and thrombosis of right subclavian vein  I82.B22  Chronic embolism and thrombosis of left subclavian vein  I82.B23  Chronic embolism and thrombosis of subclavian vein, bilateral  I82.C11  Acute embolism and thrombosis of right internal jugular vein  I82.C12  Acute embolism and thrombosis of left internal jugular vein  I82.C13  Acute embolism and thrombosis of internal jugular vein, bilateral  I82.C21  Chronic embolism and thrombosis of right internal jugular vein  I82.C22  Chronic embolism and thrombosis of left internal jugular vein  I82.C23  Chronic embolism and thrombosis of internal jugular vein, bilateral  O87.3  Cerebral venous thrombosis in the puerperium  Z79.01  Long term (current) use of anticoagulants  Z86.718  Personal history of other venous thrombosis and embolism  Z95.2  Presence of prosthetic heart valve   Coverage policy can be found in Pub. 100- 03, Medicare National Coverage Determinations Manual, Chapter 1, section 190.11 PT/INR. (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp   60.4.2  Healthcare Common Procedure Cod ing System (HCPCS) for Intermediaries  (Rev. 1562, Issued: 07- 25-08, Effective: 03-19-08, Implementation: 08-25-08)  For services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:   G0248: Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration 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 a patients ability to perform testing.