Payer Demands on a New Code are Unknown

January 30, 2018

In this month's coding column, expert Bill Dacey says requirements around the new code 93793 are unknown.

Q:   I have a question about billing the new 93793 anticoagulation management for patients taking warfarin. This is about the documentation requirements for the home/lab/INR management. If only interaction is over the phone, is this documentation enough:

home INR 2.2 on 1/16/18
INR 2.2 is within goal INR 2 to 3
thus, - continue current dose of coumadin 5mg once daily
recheck PT/INR in 2 weeks.

Or is a full “note” needed like:

S: Patient called office for ongoing evaluation and management of pt's anticoagulation.
The patient is presently taking Coumadin as documented
The patient reports the following:  (1) Bleeding/Bruising?:  NO    (2) Missed doses?: NO
(3) Double doses? NO    (4) Change in diet?:   NO    (5) Change in medication regimen? NO
Continue management of coumadin dosing as above

A:  Since these codes are so new we really don’t know what payer demands on these will be documentation-wise. That said, the first note you wrote jumps right in with results - and since the context is about the patient reporting home findings - you might want to add that first line from the second part of the second note:

“Patient called office for ongoing evaluation and management of pt's anticoagulation. The patient is presently taking Coumadin as documented”

Remember that 93793 cannot be billed during period of time covered by chronic care management or transitional care management. 93793 also cannot be billed on same day as an E/M code (thus, this is not an “add-on” if INR managed during an office visit). The best news is that this has same work RVU of 0.18, which is identical to the 99211 currently used for in-office INR management.

Q: Do you know if pediatrics can bill for depression screenings or is that part of the visit?

A:  The G0444 depression screening code that most people use is typically limited to Medicare. Even for them screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse following the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service. It is considered part of a G0402 IPPE and the G0438 - but can be billed with the ongoing G0439 AVWs.

However, these days it is often a practice-level quality requirement for annual exams that some type of depression screen be performed and documented.

For pediatrics the more common code is 96127, brief emotional/behavioral assessment, which includes things like a depression inventory and ADHD scale. This must be scored and documented. A negative test is often reported with a Z13.89 diagnosis code. The code was part of the ACA requirement that mental health treatment be part of the essential benefits provided by insurers.

Remember that the 96127 can per reported per instrument. In other words, if you do a Vanderbilt scale or a BYI-II you report the code twice.

For adults if you did a DAST-10 and a PHQ-9 – you’d report the code twice. You can use units, or put a 59 modifier on subsequent units of 96127 – that is determined by payer.