Prothrombin Time
We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for prothrombin time services.
- Authenticated physician order or intent to order prothrombin time, including frequency parameters and anticoagulation clinic if applicable.
- Authenticated documentation from the treating physician that supports the medical need for the PT.
- Referral to Anticoagulation Clinic if applicable.
- The lab results for the prothrombin time testing.
Related Content
- Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, Section 190.17 (Prothrombin Time (PT) NDC)
- Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 16, Section 40.3.1 (Critical Access Hospital (CAH) Outpatient Laboratory Service, Section 60.1.2 (Independent Laboratory Specimen Drawing)
- Centers for Medicare & Medicaid Services Internet-Only-Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.6.1 (Requirements for Ordering and Following Orders for Diagnostic Tests- Definitions)