Forum - Questions & Answers

Jan 2nd, 2020 - Krogers

Cpt codes 99473 and 99474

I am trying to figure out the correct way to code these two cpt codes. Any help would be great. I have researched and read the AMA book.

1. When I am teaching the patient how to use the BP device in office can an E&M code be billed (is it payable) with 99473?

2. The description for 99474 says a minimum of 12 readings in 30 day period but also can not report code 99474 more than once per calendar month. Do I have to wait until I have I have 12 readings before I can bill 99474 and do i bill 12 units when i bill the code?

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Jan 14th, 2020 - ChrisW   163  1 

re: Cpt codes 99473 and 99474

You cannot bill an E/M with 99473 on the same day. “99473 – Self Measured blood pressure” is used to report a NON-Face to face service for digitally stored data or remote physiologic monitoring. According to the AMA, these services should be considered part of the E/M service and not reported separately if provided on the same day.

In addition, keep in mind you cannot bill both 99473 and 99474 in the same month. You must wait for 30 days after billing 99473. Just one more tip when using these codes 99474 is a primary code and can be billed with the administration of caregiver-focused health risk assessment using 96161 if applicable.

99474 can only be billed once per calendar month. You must have the required documentation by the patient ore caregiver showing “separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings)”. This code has an MUE of "1", therefore, you will only bill 1 unit for all of the readings over the 30-day period. This information can all be found on Find-A-Codes code information page.

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