AdministrativeCommercialJuly 1, 2021

Proper coding for in-home monitoring can make a measurable difference for INR

It wasn’t too long ago when patients taking warfarin (brand name Coumadin) were heading off to the lab or clinic every few weeks for an international normalized ratio (INR) blood test. Thanks to a small, portable device, patients on warfarin can now self-test with a finger prick drop of blood. There is more to self-testing than the ease and convenience, though. Patients are happier! Their quality of life improved because they can keep up with their activities – even travel, without the stress of making and keeping testing appointments.

 

Self-testing: Measurable difference when correct coding is reflected

This type of quality care and improved outcomes are making a measurable difference in the lives of our members. We want this success accounted for in the INR clinical quality measure and with your help, we can do it. Use these codes to reflect INR In-home monitoring when noting the INR results for your patients.

 

Value set ID and subgroup

Code

Description

INR Home Monitoring

CPT code 93792

Patient/caregiver training for initiation of home 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.

INR Home Monitoring

CPT code 93793

Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab INR test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed.

INR Home Monitoring

HCPCS code 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.

INR Home Monitoring

HCPCS code 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 four tests.

INR Home Monitoring

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 four tests.


INR clinical quality measure

The percentage of members 18 years of age and older who had at least one 56-day interval of warfarin therapy and who received at least one international normalized ratio (INR) monitoring test during each 56-day interval with active warfarin therapy.

Clinical Quality Measure

Required documentation

CPT, HCPCS, LOINC and
CPT Performance Codes

Provider Specialty

INR Monitoring for Individuals on Warfarin*

Adults 18 years of age and older who have had at least one 56- day interval of warfarin therapy and received at least one INR monitoring test during each 56-day interval with active warfarin therapy in the measurement year. Excludes patients who are monitoring INR at home during the treatment period

-CPT 85610 Prothrombin time

-LOINC 34714-6 INR blood by coagulation assay

-6301-6 INR in platelet poor plasma by coagulation assay

-38875-1 INR in platelet poor plasma or blood by coagulation assay

-46418-0 INR in capillary blood by coagulation assay

-52129-4 INR in platelet poor plasma by coagulation - post heparin adsorption

 

Excludes:

-G0248 Demonstrate use home INR monitoring

-G0249 Provide test materials and equipment for home INR monitoring

-G0250 Physician INR test review interpretation and management

No provider type restrictions


1231-0721-PN-CNT

PUBLICATIONS: July 2021 Anthem Provider News - Indiana