Ensure Proper Reimbursement for Glucose Monitoring Under Medicares Policies
Published on Thu Mar 01, 2001
Reimbursement for blood glucose determinations depends on assigning the proper procedural code based on the testing method, as well as properly applying Medicares coverage policies to these tests. In response to the rising use of glucose monitoring devices approved for home use, Medicare has issued special coverage and payment instructions that must be followed to gain reimbursement.
Coders need to be aware of the criterion for the various blood-glucose codes (e.g., 82947-82952) and especially for the burgeoning home-use glucose meters (82962), says Stan Werner, MT (ASCP), administrative director and corporate compliance officer of Peterson Clinical Laboratory in Manhattan, Kan.
Blood glucose tests are carried out using whole blood, serum or plasma. The blood is typically obtained by fingerstick or vein puncture. When the specimen is taken at the laboratory, the collection service is separately billable as CPT 36415 (routine venipuncture or finger/heel/ear stick for collection of specimen[s]) or G0001 (routine venipuncture for collection of specimen[s]) for Medicare patients, Werner says. But applying the proper code for the glucose test depends on under-standing the methodology.
The glucose determination is made by one of three basic techniques, and this dictates the appropriate procedural code, Werner says. They are as follows:
82947 (glucose; quantitative, blood [except reagent strip]): This is the code often used in clinical laboratories such as ours, and it describes reagent-based blood glucose assays with an end point determined by instrumentation, such as the hexokinase method on an autoanalyzer, Werner explains. These are quantitative tests and are generally more accurate than either the test strips or home-use devices, Werner says.
Although most of these tests are approved only for laboratories with a moderate complexity or higher license, the HemoCue G-Glucose Photometer is approved for labs that are granted waived status under the Clinical Laboratory Improvement Amendments (CLIA) standards. A lab with waived status is not required to meet the more rigorous standards of labs that perform tests of moderate or high complexity. As such, these labs are limited to tests that are simple to perform and low-risk for patient outcome. For a lab with CLIA-waived status, the proper code for this service is 82947-QW (CLIA waived test).
82948 (glucose; blood, reagent strip): This test involves a color comparison of an indicator stick. This is a quick method, but has become less common as the home-use meters have become more prevalent.
82962 (glucose, blood by glucose monitoring device[s] cleared by the FDA specifically for home use): Home-use blood glucose monitoring devices provide a rapid blood sugar reading from a whole blood finger-prick. The instruments operate on enzyme assays or electrochemical methods and spectrophotometry, providing a quick digital readout. Because of the ease of use and the precision [...]
