Cardiology Coding Alert

Always ask specific payers for their individual INR rules.

A subscriber recently wrote in with a tricky international normalized ratio (INR) situation he encountered in his cardiology practice. If you’ve wondered how to correctly bill INR codes such as 93793, you will want to see how our coding pro tackles the case.

Find out how you can overcome the challenges of INR coding with this expert’s advice.

The case: I was under the impression that patients with home INR machines were required to check INRs weekly. We used to bill after four tests and were reimbursed around $20. With code 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)), is it true that we can bill on a weekly basis or even more than that if necessary? For example, if the INR is on target, the provider still checks it weekly, with no adjustments. Can we bill for 93793 four times for that month?

Here’s What to Do

The solution: You should report 93793 for managing patients taking warfarin, explains Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. Code 93793 includes the review and interpretation of a new lab test done in a home, the office, or the lab. This code’s relative value unit (RVU) is for the work done to interpret the lab results, make a dosing adjustment if needed, and scheduling additional tests when and if needed. A dosage does not need to be changed to report 93793.

Don’t forget: You cannot report 93793 more than once per day regardless of the number of tests the provider reviews, reminds Neighbors.

However, you can report HCPCS code 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) for every fourth home PT/INR result the provider interprets and adjusts, Neighbors adds.

Remember: To report G0250, there must be record of at least four individual results and/or interpretations and at least four weeks (28 days) between claims submission.

Examine The E/M Angle

You may report a new or established evaluation and management (E/M) code in addition to INR codes 93792 and 93793 as long as the E/M service is significant and separately identifiable. You must also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code, according to Neighbors. Additionally, these codes do not include test materials and equipment, which you would report separately with 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).

Always Mind Specific Guidelines

“I recommend following Medicare guidelines to be standardized across-the-board regardless of payers. This means at least four individual result and/or interpretations (once per week) and at least 28 days between claims submissions,” Neighbors says. “Most payers follow Medicare guidelines, so if you are reporting with a HCPCS or numeric CPT^® code, the same policy procedures will be followed.”

However, some payers have specific INR guidelines, so I extremely recommend researching each payer before submitting your claims, Neighbors adds. Some plans and/or payers may also consider this procedure experimental and may not cover it at all.