Oncology & Hematology Coding Alert

Question: Our physician adjusted the warfarin dose for a patient during follow up in the outpatient clinic. He also ordered for INR testing and reviewed it. How can we report these services?

Georgia Subscriber

Answer: To be able to describe definite codes, you will need to check the duration of the anticoagulation. To report the warfarin (anticoagulant services) management and dose adjustment, you can choose from the following two codes:

• 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]), and
• 99364 (……each subsequent 90 days of therapy [must include a minimum of 3 INR measurements]).

List the included services: These codes are inclusive of ordering, review, and interpretation of the International Normalised Ratio (INR) testing. Also included are the communication with the patient for the anticoagulant requirement and any dose adjustments for warfarin or other anticoagulants.

Meet the minimum monitoring test requirements: The code 99393 applies to a minimum of 8 INR measurements in the initial 90 days of therapy and the code 99364 includes a minimum of 3 INR measurements in each subsequent 90 days of therapy. If your provider does not document these minimum numbers of measurements in the specified period, you may not submit codes 99363 or 99364.

Also: Another key to reporting these codes is that you do not submit the codes for a period less than 90 consecutive days of outpatient evaluations.

E/M codes: You should not use the codes 99363 and 99364 as basis of reporting an E/M service or care plan. If your provider performs a separate identifiable E/M service, you may use the applicable E/M codes and 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)