Ob-Gyn Coding Alert

Question: Medicare denied CPT 82948 with denial B7 (this provider was not certified for this procedure/service on this date of service). Our CLIA# is for provider-performed microscopy. Are we using the correct code? We do a finger stick and readout on a glucometer.

Bonnie Mastrosimone
White Memorial GYN/OB Medical Group, Los Angeles

Answer: The blood glucose level determined by reagent strip method (82948, glucose; blood, reagent strip) is obtained by placing a drop of blood on the glucose oxidase strip, blotting the strip at a prescribed interval and then usually comparing the color of the strip (after it has been allowed to react with the blood) against a comparison color chart on the side of the vial that contains unused reagent strips. The determination of blood glucose by using the glucose monitoring device (82962, glucose, blood by glucose monitoring device[s] cleared by the FDA specifically for home use) is a more precise method than the visual comparison method described in code 82948.

Code 82962 describes the method when whole blood is obtained (usually by finger stick device) and assayed by glucose oxidase, hexokinase or electrochemical methods and spectrophotometry using a small portable device designed for home blood glucose monitoring. The devices also are used in physician offices, during home visits or in clinics.

When they are used in a setting other than a home, code 82962 is also the appropriate code to report. Here the timing of the sample reaction with the detection strip may be automated, although many of the devices are not, and a direct analog readout of the result is provided. The accuracy of the result largely depends on the use of proper methodology for the collection of the specimen and the timing of the reaction by the operator.

The code 82948 is classified as a moderately complex test and therefore would be denied if you only have a PPM (provider-performed microscopy) certificate as you have stated. The code 82962, on the other hand, is a CLIA-waived test for which I believe you would qualify.