How to Properly Report Monitoring Patients Taking Blood-thinning Medications

There are two new codes, as of January 2019, to describe services related to International Normalized Ratio (INR) monitoring:

• 93792 describes face-to-face training of the patient (and/or caregiver) on how to use and care for their INR monitor, obtain and test blood samples, and report INR test results from home, rather than going to the laboratory. Since there is no physician work RVU assigned to this code, it could be rendered by clinical staff or case managers under the general supervision of a physician or qualified healthcare provider (QHP).
• 93793: describes work performed by a  physician orQHP (e.g., Nurse Practitioner, Physician Assistant) who performs anticoagulant management for a patient takingwarfarin (a blood thinner). It includes ALL of the following:
  • order, review and interpretation of INR test results (whether performed in the office, home, or lab),
  • dosage changes, as needed,
  • patient instructions
  • scheduling additional testing

It is essential to note the official CPT Guidelines regarding the use of these codes. For either code, DO NOT:

• Report these codes in conjunction with telephone or online services (98966, 98967, 98968, 98969, 99441, 99442, 99443, 99444), or
• Count anticoagulant management time as part of chronic care management (99487, 99489, 99490) or transitional care management (99495, 99496).

Some additional things to note about code 93793 are:

• Service includes ALL of the following:
• ordering, reviewing, interpreting new INR test result(s)
• providing patient instructions
• making dosage adjustments, as needed
• It may only be reported once per day, regardless of the number of INR tests reviewed

The March 2018 CPT Assistant clarifies that there may be situations where you could report code 93792 in conjunction with E/M services, but ONLY if there is a significant, separately identifiable E/M service which would then qualify that E/M service to be reported using modifier 25. However, it is not appropriate to report an E/M service with 93793 — even with a modifier — on the same day because management services because it is considered to be included (bundled) with the E/M service.

Carefully review individual payer policies as some may have additional restrictions such as any or all of the following:

• The home monitor must be FDA approved
• A trial period of physician/QHP monitoring must be completed
• Testing limited to once per week
• Only certain diagnosis are allowed (e.g., I27.82, D68.51)

Tips:

• INR test supplies and materials may be reported separately using code 99070
• If the blood draw is performed in the physician’s office and processed in their in-office lab, code 85610 (Prothrombin time) may also be reported
• For patients with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism, codes G0248, G0249, and G0250 might be appropriate to be used as long as they are allowed by the payer and the code criteria are met.

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