Forum - Questions & Answers

Nov 10th, 2016 - cmgmr 4 

Continuous Glucose Monitoring coding/billing confusion

Our practice has recently begun ordering CGM for some of our patients and there is a lot of confusion regarding the billing for the Data Interpretation.

The two examples I have are as follows: order was generated by the Physician in the Primary Care Center for 72 hour glucose monitor and the patient presents to the Diabetic Educator for the CGM Startup and Instruction. In this instance the Diabetic Educator is employed by the Hospital affiliated with the Primary Care Center. The Diabetic Educator billed for the 95250 thru the Hospital Billing system. She provided the reports for data interpretation to the Primary Care Provider. Is the Primary Care Provider billing only 95251 for data interpretation? There was no face to face visit with the patient to review the results, only telephone encounter so no E&M would be billed.

In order to make this service billable would there would have to be an appointment created for the date it was reviewed with the patient (via telephone)? We can't create a claim without an appointment, correct?

This is all new to me and I have been given very little information on how to proceed. Any input is greatly appreciated.

Nov 10th, 2016 - LBAROGIANIS 250 

re: Continuous Glucose Monitoring coding/billing confusion

TRY 99091:

Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time

Nov 10th, 2016 - LBAROGIANIS 250 

re: Continuous Glucose Monitoring coding/billing confusion

You can't bill all these codes together on the same date, hence the 72 hour test, 99091, 95250 and 95251. So if the physician gets the data 3 days later and interprets it then.. that is the date you would use..

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