INR Monitoring Code Changes Coming (But Old Faves Could Stick Around, Too)

patient training

If you code for anticoagulant management — and a lot of folks do — you’ll need to get a handle on some changes headed our way when CPT® 2018 is effective on Jan. 1, 2018. Here’s the scoop.

Let’s Start With What’s In and What’s Out for CPT®

Out: In CPT® 2018, these two codes will be deleted:

  • 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements))
  • 99364 (… each subsequent 90 days of therapy (must include a minimum of 3 INR measurements)).

In: In their place, you’ll have these two new codes. Note that the 2017 codes started with 99, but the 2018 codes start with 93:

  • 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).

Remind You of Some Other Codes?

Here’s a little history from the proposed 2018 MPFS. The RVS Update Committee (RUC) recommended that the CPT® Editorial Panel create Category I codes that describe the services described by INR monitoring codes G0248-G0250. Those HCPCS codes, shown below, fall into the category of Medicare use of 10,000 or more with an increase of at least 100 percent from 2008 to 2013. Here are the HCPCS codes:

  • G0248 (Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results)
  • G0249 (Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests)
  • G0250 (Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests).

What does the future hold? With the creation of the new Cat. I codes, the RUC recommended that CMS delete G0248-G0250. But according to the proposed MPFS, Medicare doesn’t plan to delete the codes for 2018 because you use them to report services under a National Coverage Determination. Under the NCD, Medicare covers home PT/INR monitoring for beneficiaries on warfarin who meet certain conditions, including those outlined in the descriptors: patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria.

What About You?

Do you code these services? Do you expect to use the new Cat. I codes?

 

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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