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  

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)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

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

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association