Endocrinology Coding Alert
You Be the Coder: Does In-Office Glucose Monitoring
Question: An endocrinologist who just started with our practice has been performing in-office glucose monitoring. She wants to bill for the monitoring device with 82962, and the strips and finger stick with 82948. She also wants to bill an E/M code for the office visit. When I bill the services this way, Medicare denies payment. Should I use a different code to bill for these services?
Mississippi Subscriber
Answer: If your endocrinologist uses a glucometer to measure blood glucose levels, you should use 82962 (Glucose, blood by glucose monitoring device[s] cleared by the FDA specifically for home use). Remember that if you are reporting CLIA-waived test codes to Medicare, you must append modifier -QW (CLIA-waived test). The National Correct Coding Initiative bundles 82962 with 82948 but does allow you to use modifier -59 (Distinct procedural service) to try to separate the tests if you believe the services should not be bundled. Payers will generally pay for 82962 if you report this code alone.
If your practice performs only a simple blood glucose test, you should report 82948 (Glucose; blood, reagent strip) only. Diabetic patients sometimes come in just for lab visits to check the accuracy of their own blood glucose meters against the lab's results to make sure their meters are functioning properly. If a patient sees the endocrinologist for a blood glucose test as part of the visit, you can bill for the E/M service and 82948.
When the physician or nurse collects three blood specimens and administers glucose, report 82951 (Glucose; tolerance test [GTT], three specimens [includes glucose]). For each additional specimen after the third, use 82952 (... tolerance test, each additional beyond three specimens).
Blood specimen collection is not bundled with the GTT codes and you can report the collection separately, according to the February 2001 CPT Assistant. Because many physicians collect specimens from diabetic patients with finger sticks, you can bill 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for this service.
Endocrinologists also use continuous glucose monitoring systems (CGMS) to monitor blood glucose. The patient wears the device for 72 hours before returning to the office to disconnect the device and download the results (for tips on coding CGMS, see our article "3 Field-Tested Tips Improve Your CGMS Claims" in the May 2004 Endocrinology Coding Alert). If your endocrinologist uses a different method to monitor blood glucose and you can't locate an appropriate code, call your Medicare carrier and ask how you should code for the service.
- Published on 2004-08-26
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