There are a few remarkable things about coding for anticoagulation management services.

First, payment for these services bolsters Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and before these codes were developed, the work was considered part of the pre-and post-work for an office visit. Although there were CPT^® codes for anticoagulation management prior to 2018, when these codes were valued, they had a status indicator of bundle and were not reimbursed by any payers.

Second, although the payment is low particularly for the management in response to the INR test, some practices perform this service frequently. It is payment for management work that is already being done.

Currently, there are two sets of codes, two CPT^® codes and three HCPCS codes. They aren’t defined consistently and this article explains the differences.  The HCPCS codes relate only to home INR monitoring, while one of the CPT^® codes can be used when the test is done in the home, office, or lab.

Home and Outpatient International Normalized Ratio (INR) Monitoring Services

These codes are used in the management of warfarin therapy. CPT^® states that a separate E/M service may be reported with code 93792, caregiver training, but may not be reported with code 93793 which is the management of the medication based on test results. CPT^® also notes that 93793 may not be reported on the same day as CPT^® telehealth codes.

93792 Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient’s/caregiver’s ability to perform testing and report results

93793 Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed

93792 is for patient/caregiver education for initiation of home international normalized ratio (INR) testing. The patient obtains the equipment from a DME provider (“the provision of test supplies and materials is reported separately with code 99070, Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided), or the appropriate supply code.)[1] to test their own blood at home, and prior to doing the testing, a staff member has a face-to-face educational session with the patient, showing them how to collect the sample and test their blood, and documenting their ability to perform the tests and report the results. 99070 has a status indicator of bundled. Medical practices are not paid for providing supplies to patients. 93792 was assigned zero wRVUs, because it is staff work only, but does have a total RVU value and an associated payment.

93793 is for a non-face-to-face review of INR results and management. It is payment for reviewing the results of an INR done at home, at the office, or in a lab.

Now, to the older, HCPCS codes that relate only to home INR services.