CPT developed (and Medicare recognizes) two new codes for services related to home and outpatient international normalized ratio (INR) monitoring services in 2018.
Here are the new codes | CPT® 93792, 93793
93792 Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified healthcare 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 Anticoagulation management for patients taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR)test results, patient instructions, dosage adjustment (as needed), and scheduling of additional test (s), when performed
Both have a status indicator of “A”.
|Code||Brief description||Status indicator||Work RVU||Total facility RVU||Total non-facility RVU||National payment amount|
|93792||Pt/caregiver train home inr||A||0.00||1.48||1.48||53.33|
|93793||Anticoag mgmt pt warfarin||A||0.18||0.34||0.34||12.25|
There’re a few remarkable things about this.
First, it continues Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and up till now, was considered part of the pre-and post-work for an office visit. Although there were CPT® codes for anticoagulation management, 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 work that is already being done.
93792 is the code used for patients who test their INR at home, rather than going to the laboratory. Prior to starting this home testing, the patient needs to understand how do use the test reliably. This instruction and training is now covered service. Notice that for patient/caregiver instruction and training, there are no work RVUs assigned. This is work that would typically be done by clinical staff or case managers.
93793 Is payment for managing patients taking warfarin. It includes the review and interpretation of a new lab test done in the home, office or lab. This code does have work RVUs, recognizing that it is physician/NP/PA work to interpret the lab results, make a dosing adjustment if needed, and schedule additional tests, again if needed. The dosage does not need to be changed in order to report 93793. It is for a new test result.
Can these be performed on the same day as an E/M service?
CPT® says that a separately identifiable E/M service may be reported on the same day as 93792, instructions and training for a patient who will start home INR monitoring.
“Do not report 93793 on the same day as an E/M service.”
So, if the INR is done on the day of the visit and the physician/NP/PA interprets the result and gives the patient dosage instructions, do not report 93793 in addition to the E/M.
CPT® also states not to report either code during the service time of chronic care management (CCM) or transitional care management (TCM). (99487, 99489, 99490, 99495, 99496) During the service period would mean during any calendar month of reporting CCM and during the 30-day post discharge period if billing TCM.
This is good news. It is payment for services medical groups are already doing.
For additional information see:
Watch Betsy’s 60 minute on-demand webinar “Care Management in Primary Care Practices” for a review of the coding rules as well as tips for doing, and documenting care management services. Webinars are free for members.