How to earn money monitoring INR levels

Prior to 2018, payers considered international normalized ratio (INR) monitoring (i.e., the testing and dosage adjustments required to manage warfarin therapy) part of the routine work associated with an office visit. This meant payment was bundled into the evaluation and management (E/M) code when physicians performed these services.

Now, two new CPT codes allow payment when physicians order, review, and interpret new INR test results-even when patients self-test at home: 93792 (patient/caregiver training for home INR monitoring) and 93793 (anticoagulation management for a patient taking warfarin).
This is good news for physicians who frequently treat patients on warfarin, because it means they’ll be paid separately for work they’re already doing, says Rhonda Granja, CPC-I, CPC, lead instructor at the Medical Management Institute in Atlanta. Many physicians still don’t know about these codes even though they’ve been active for more than a year, which means doctors are probably leaving money on the table, she adds.

Consider these four questions before billing for INR monitoring:

1) Do commercial payers reimburse for the service? Ask commercial payers to include CPT codes 93792 and 93793 in their contract if they haven’t done so already. Don’t assume payers will automatically cover these services just because Medicare does, says Granja.

2) Will patients have the option to monitor their INR levels at home? Home INR monitoring isn’t only convenient for patients-it also frees up the schedule so physicians can focus on face-to-face visits with patients who have acute problems, says Norman Vinn, DO, family medicine home care physician in Laguna Hills, Calif. Home monitoring also has potential clinical benefits. “You can rapidly get answers and provide almost instant turnaround on dosage advice,” he adds.

One caveat is that not every patient will have the physical and mental abilities to perform INR tests at home, says Vinn. “The operator reliability must be reasonably accurate and consistent,” he says.

Vanessa Vinn, DO, internist in Costa Mesa, Calif. adds that younger and more tech-savvy patients may be the best candidates for home INR monitoring.

3) How will patients receive INR test results? What workflow will the practice use to communicate results and dosing adjustments? For example, will patients come into the office? Will a physician or nonphysician provider call them? Will staff send results through the EHR portal? A combination? These decisions will ultimately drive how the practice will bill for these services, says Granja.

4) How will the practice capture revenue? There are several ways in which physicians can bill for INR monitoring. The specific scenario and supporting documentation will dictate the most appropriate and compliant method. Granja provides the following scenario advice:

Patient monitors INR level at home and comes into the office to discuss results.

Report CPT code 93793. Don’t forget to bill CPT code 93792 for the initial patient/caregiver training to provide education regarding use and care of the INR monitor, how to obtain a blood sample, and how to report home INR test results.

Patient goes to an external lab for an INR test and comes into the office to discuss results.
Report CPT code 93793.

Patient has an INR test at a lab in the office or at the point of care and follows up with a visit to discuss results.
Report CPT codes 85610 (prothrombin time) and 93793.

Patient presents for an office visit during which the physician also discusses INR monitoring.
Report CPT code 93793 and the appropriate E/M code with modifier -25. Another option is to report the E/M code with a prolonged service code (CPT codes 99354-99357), but only when documentation includes a detailed description of the additional time spent-what the physician did and why.

Patient requiring INR monitoring already receives chronic care management (CCM) services.
Include the INR monitoring in your total CCM time, and report the CCM only (CPT codes 99487, 99489, or 99490). Note that INR monitoring alone doesn’t constitute CCM.

Patient monitors INR level at home or goes to an external lab for an INR test, and the physician or a nonphysician practitioner provides results and instructions via telephone or electronic communications (e.g., through the portal).
Report a CPT code from the 98966-98969 or 99441-99444 ranges.

Patient has an INR test at the lab in the office, and the physician or a non-physician practitioner provides results and instructions via telephone or electronic communications (e.g., through the portal).
Report CPT code 85610 and a CPT code from the 98966-98969 or 99441-99444 ranges.