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CINDY Posted 4 month(s) ago
Does 93793 replace G0250 or can both be billed together and is 93793 to be used when we call patients with other lab results?
SuperCoder Posted 4 month(s) ago

 

 

Hi,

Here is some information about CPT code 93793 :

93793 is payment for managing patients taking warfarin. It includes the review and interpretation of a new lab test done in the home, office or lab. This code does have work RVUs, recognizing that it is physician/NP/PA work to interpret the lab results, make a dosing adjustment if needed, and schedule additional tests, again if needed.  The dosage does not need to be changed in order to report 93793.  It is for a new test result.

Medicare will cover the use of home PT / INR monitoring for chronic, oral anticoagulation management for patients on warfarin with: Mechanical heart valves, Chronic atrial fibrillation,Venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism).The monitor and the home testing must be prescribed by a treating physician meet all of the following requirements:

The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,

The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,

The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,

Self-testing with the device should not occur more frequently than once a week.

Billing

Medicare coverage criteria:

Includes provision of materials for use in the home

Reporting of test results to physician

Not occurring more frequently than once a week

Includes materials for 4 tests

Therefore, the patient is self-testing once a week for 4 weeks (7 days / week x 4 = 28 days) and reports results to their physician. Once the patient has completed their testing, occurring no more frequently than once a week, the physician reviews and interprets the results of those 4 tests.

The physician's service is billed with procedure code G0250, no more frequently than once every 4 weeks or every 28 days (7 days / week x 4 = 28 days). There must be 28 days between each submission of G0250.

For further information consider the following link :

http://blog.supercoder.com/coding-updates/inr-monitoring-code-changes-coming-but-old-faves-could-stick-around-too/

Hope this helps!

 

Posted by CINDY, 4 month(s). There are 2 posts. The latest reply is from SuperCoder.

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