General Surgery Coding Alert

Don't miss these code addition and deletions.

Surgical treatment can be complicated by a patient on anticoagulant medication such as Coumadin.

If your surgeon becomes involved in anticoagulation medical management, you need to learn a new way toreport the service. Read on to get a grasp of CPT®  2018 changes that will impact how you code these claims.

These are Out

CPT^® 2018 deletes the following two codes that described anticoagulant management services:

• 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).

These deleted codes were in the E/M section and focused on the treatment duration - 90 days of anticoagulant management - as opposed to the specific tasks the physician or other qualified health care professional performed. As such, surgeons often found that using these codes was not appropriate, even when they had to monitor patient anticoagulant therapy during the surgical global period.

These are In

CPT^® 2018 adds the following new 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 ...)
• 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).

Opportunity: You can see that the new codes focus on the actual services provided, rather than on the 90-day monitoring period. Also note that these codes are in the medicine section, and they might be separately billable when surgeons perform these services as part of patient management during the global surgical period.

"This change helps to better understand the type of service that is being provided," according to Suzan Hauptman, MPM, CPC, CEMC, CEDC AAPC fellow, senior principal of ACE Med Group in Pittsburgh. "Checking a patient's lab results around their INR and adjusting the medication may not require a face-to-face service or the attention of the physician; both two components of most all E/M services."

"Assigning this type of service a code in the medicine section allows the service to be more accurately represented," Hauptman adds.