Anticoagulant Therapy and Home Care

[JennyHHRN]

Okay, I know back in 1997 Medicare said venipuncture is no longer covered as the sole purpose for home care visits. We can continue to draw blood at our visits as long as they have visits for other "skilled reasons". So what do you do with the homebound medicare beneficiary who has been placed on Coumadin and physician wants PT/INR drawn every two weeks. Her Coumadin dosage is dependent upon the lab results. She will be on Coumadin for life. How is it any different than a patient that needs Foley cath management or monthly B-12 injections?

And what is the purpose of the following V-Codes:

V58.61 Long-term (current) Use of anticoagulants

V58.83 Encounter for therapeutic drug monitoring

Are they not for Home Health usage???? Are they just FYI codes to put on the 485???

Do you have patients on service like this??? If so, I'm up for any education on the matter.

[CardioTrans, BSN, RN]

If the patients INR is abnormal and the Coumadin dose is changing then you can continue to see the patient for those labs. The agency that I work at uses those codes for patients on Coumadin. We typically dont use them as primary codes though. Maybe A fib, depending on what they are on the med for. Focus on education related to the coumadin and the underlying diagnosis. Education is a skill.

We have a rule of thumb, if you will, that if the coumadin dose does not change for 3 consecutive lab draws, then it is not considered a reason for the nurse.

Hope that helps.

[renerian, BSN, RN]

Agree with cardio........I have seen some agencies use a 2 draw rule/no titration/dc and set up a lab to do home draws.

ren

[JennyHHRN]

Thanks Guys...I was thinking along those same lines but needed to hear it from others. I swear sometimes I have so many priorities to juggle that it becomes difficult to solve even the simplest of items.:selfbonk:

[renerian, BSN, RN]

Jen,

I know I bounce things off people here alot. Your very welcome.

ren