3 Field-Tested Tips Improve Your CGMS Claims

Billing 95250 as a separate encounter is the key to reimbursement
You can recoup optimal payment for a continuous glucose monitoring system (CGMS) if you report E/M visits for the physician's insertion and interpretation work, and bill 95250 when you disconnect the CGMS device.

CGMS allows physicians to determine exactly what occurs in a diabetic patient's blood glucose level during a 72-hour period, says Elaine Rehmer, CPC, an administrator at the Cosmopolitan Diabetes Center in Columbia, Mo.

Endocrinology coders who report an E/M visit and 95250 (Glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor [includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data]) on the same day often face denials, she adds. You can increase your payment success rate by coding CGMS in three stages:

1. Code an E/M visit on the day of the CGMS insertion. Most of the time you will bill a high-level E/M code such as a 99214 (Evaluation and management of an established patient ...) for this service because the endocrinologist will perform a detailed examination, review lab results and consider the patient's current plan of care before deciding that CGMS is necessary, Rehmer says. The physician will also spend time inserting the device and teaching the patient how to calibrate and use it properly, she adds.

Note: CPT states that 95250, which you should bill on the day you disconnect the CGMS, includes hook-up and patient initiation and training. If the patient returns specifically for device hook-up and training, don't charge an E/M code for that visit, says Charla Prillaman, CPC, CHCO, director of physician compliance for Carolinas HealthCare System in Charlotte, N.C. You will account for those services when you bill 95250.

In summary: If your physician performs an E/M service on the same date as CGMS insertion, you should report only an E/M code. If your physician performs no E/M on the date of CGMS insertion, you should report no codes for this date.

2. Report 95250 on the day the physician disconnects the CGMS. When the patient returns three days later, a nurse or the endocrinologist will disconnect the patient from the device and download the data. Code 95250 is the only code you should report for this visit, Rehmer says.

3. Code an E/M visit when the patient returns to review the data with the physician. CPT instructs you to use E/M service codes to report the physician review, interpretation and written report associated with code 95250. If the endocrinologist disconnects the patient's CGMS device and discusses the results with her during the same visit, you may consider reporting an E/M code for the [...]

- Published on 2004-05-20