Primary Care Coding Alert

Question: When a patient returns for the report after a 72-hour glucose monitoring (95250), should I use an E/M code? If not, which code should I use?

Ohio Subscriber

Answer: If the physician sees the patient and discusses the report with the patient, you should code this encounter with an appropriate E/M code, such as 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ). Code 95250 (Glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor [includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data]) does not include the physician review, interpretation and written report associated with the glucose monitoring code, nor would it include any subsequent counseling with the patient regarding the report results.

For CPT purposes, counseling associated with E/M codes includes discussion with a patient regarding several factors, including diagnostic results, impressions, and/or recommended diagnostic studies; risks and benefits of treatment options; and instructions for treatment and/or follow-up.

If counseling dominates (more than 50 percent) the encounter when the FP discusses the report with the patient, you should code the E/M service based on time. For instance, if the FP spends 15 minutes on the visit with 100 percent of the time discussing the diagnostic results, you should report the visit with 99213 ( physicians typically spend 15 minutes face-to-face with the patient).