How to Properly Report Monitoring Patients Taking Blood-thinning Medications

June 18th, 2019 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   HCPCS Coding   Diagnosis Coding   Modifiers   Cardiology|Vascular   Home Health|Hospice   Internal Medicine   Neurology|Neurosurgery   Obstetrics|Gynecology   Orthopedics   Pediatrics   Primary Care|Family Care   Skilled Nursing   Billing  
0 Votes - Sign in to vote or comment.

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:

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., I27.82D68.51)

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.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
OIG Investigates SCAN Health for Risk Adjustment Overpayments With Surprising Results
July 26th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
Addressing Trauma and Mass Violence
July 21st, 2022 - Amanda Ballif
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
The 'Big 2' HIPAA Rules Medical Billing Companies Must Follow
July 20th, 2022 - Find-A-Code Staff
HIPAA covers nearly every aspect of how medical and personal information is collected, utilized, shared, and stored within the healthcare industry. Title II of the rules is applied directly to medical billing companies and independent coders. The 'Big 2' rules that medical billing companies must adhere to revolve around privacy and security.
The Beginning of the End of COVID-19-Related Emergency Blanket Waivers
July 19th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association