New Insulin-Pump Coverage Ruling May Bump Up Your DME Income

CMS updates fasting C-peptide testing requirement that qualifies diabetics for CSII coverage
If your practice distributes insulin pumps and supplies to Medicare patients, you may reap the reimbursement benefits of a new CMS coverage decision.
 
CMS has updated the fasting C-peptide testing requirement that qualifies diabetic patients for continuous subcutaneous insulin infusion (CSII), the agency announced in a Sept. 30 draft decision memo. The new C-peptide requirement includes a determination that "fasting C-peptide levels will only be considered valid with a documented, concurrently obtained fasting glucose less than or equal to 225 mg/dL," CMS states.
 
The new deal: This new coverage decision means CMS now covers CSII for diabetic patients who:
 
are documented (once) to either meet the updated fasting C-peptide testing requirement or be beta cell autoantibody positive; and
 
satisfy the remaining criteria for insulin pump therapy detailed in the Medicare National Coverage Determinations Manual (Medicare NCD Manual 280.14, Section A.5).

DME billing: Many endocrinology practices have an arrangement with a durable medical equipment supplier that stocks their office with insulin pumps (E0784, External ambulatory infusion pump, insulin) and supplies and also takes care of the billing. This arrangement can work nicely because the practice has pumps available for office use and doesn't have to bother with billing the Medicare DME carrier.
 
However, some practices may choose to handle their own distribution and billing for insulin pumps, says Eddye Sheffield, CPC, billing supervisor for MedCorp, a billing and consulting company in Gadsden, Ala., that handles some endocrinology billing. These practices may benefit from Medicare's new insulin pump coverage requirements.
Brush Up on C-Peptide Test Coding
The basics: Endocrinology practices report the fasting C-peptide test with 80432 (Insulin-induced C-peptide suppression panel), and the test panel must include:
  
insulin (83525)
  
C-peptide (84681 x 5)
  
glucose (82947 x 5).

Revenue potential: Completing the C-peptide suppression panel can be an all-day ordeal, and you deserve payment for your physician's time and all the blood draws, Sheffield says. Whether your practice uses an in-office lab or sends blood samples to an outside lab for analysis, you're losing money if you don't account for the other rendered services that day.
 
Plan: Sheffield recommends reporting the following charges to account for services on the day of a C-peptide test:
 
E/M code (because the physician performs an initial assessment on the patient to determine the current status of his diabetes)
 
Blood draw codes G0001 (Routine venipuncture for collection of specimen[s]) for Medicare patients and 36415 (Collection of venous blood by venipuncture) for patients with other insurance
 
Finger stick code (36416, Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for [...]

- Published on 2004-11-21