Pathology/Lab Coding Alert

Question: We operate a CLIA-waived-status lab that performs routine monitoring services for patients in a rural area. We perform weekly protime tests for patients on anticoagulation therapy, and blood glucose monitoring for diabetics. Recently, we have been getting denials for Accu-Check blood-sugar tests billed with 82962. The payer states that the testing device is only for home use and, therefore, the test is not covered for inpatients or outpatients. Is the payer correct in denying the charge for this reason?

Missouri Subscriber

 
Answer: Home-use blood-glucose monitoring devices are covered by Medicare and many other payers subject to medical necessity and frequency limits. Most of these devices provide a rapid blood-sugar reading from whole blood obtained by a finger stick. Because these instruments operate on enzyme assays or electrochemical methods and spectrophotometry, with results provided in a quick digital readout, they are both easier to use and more precise than older colorimetric test strips.
 
As such, these devices are quickly becoming the standard for point-of-care testing, even in the inpatient setting. Many of these tests by various manufacturers are approved for labs with CLIA-waived status. Medicare clarified that this test is covered for other than home use in program memorandum AB-00-108 (Dec. 1, 2000).
 
The memo states, If home-use glucose monitoring devices are used in the hospital and nursing-home settings, a glucose monitoring service must be performed in accordance with laboratory coverage criteria to qualify for separate payment under the Medicare laboratory benefit. These criteria are that the test must be ordered by a physician and administered by a healthcare provider registered under CLIA with at least a certificate of waiver, and the results of the test must be reported to the physician and be used to instruct continuation or modification of patient care.
 
The AMA also clarified the use of this code in CPT Assistant, Jan. 1999. The article states, CPT code 82962 (glucose, blood by glucose monitoring device[s] cleared by the FDA specifically for home use) 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 use. These devices may also be used in physician offices, during home visits or in clinics.