Primary Care Coding Alert

Question: Our provider regularly performs finger-stick glucose tests on diabetic and prediabetic patients. Which is the correct code to use for this service: 82948 or 82962? And what is the difference between the codes?

Codify Subscriber

Answer: The two tests you mention, 82948 (Glucose; blood, reagent strip) and 82962 (Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use), determine glucose levels in two different ways.

The 82962 service is an automated test where the patient or doctor uses a small portable device to read a test strip that has a small sample of the patient's blood obtained by sticking the finger with a small lancet. The strip is inserted into the device, and after a few seconds, the patient's blood sugar appears as a digital readout. These devices are typically for use by patients in their homes, hence the information contained in the procedure's descriptor that states the Federal Drug Administration (FDA) has cleared the test for home use. However, many primary care offices use the same test for a quick evaluation of the patient's current glucose levels.

The 82948 service, on the other hand, is a slightly different test. While it, too, involves placing a sample of the patient's blood on a test strip, 82948 then determines the patient's blood sugar levels by comparing the color of the test strip after it has reacted with the patient's blood to the colors on a color chart provided with the test kit.

In order to perform either test, your office must first have a Clinical Laboratory Improvement Amendments (CLIA) certificate from the Centers for Medicare & Medicaid Services (CMS). (Information about obtaining a certificate can be obtained by going to https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/How_to_Apply_for_a_CLIA_Certificate_International_Laboratories.html.)

Then, once you have determined which of the tests is most appropriate for your provider to use, you will need to determine your level of participation in the CLIA program.

The 82962 service is listed as a CLIA-waived test, meaning that CMS regards it one of a group of "simple tests with a low risk for an incorrect result." (You can find a complete of these tests at https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/waivetbl.pdf.) In order to perform it and any of the other CLIA-waived tests, you simply pay certificate fees to the program biennially and follow any instructions provided by the test manufacturer.

Additionally, for billing purposes, you will append HCPCS modifier QW (Clia waived test) when needed to the appropriate CPT^® code for many of the tests. The 82962 code, however, is one of those tests that does not require you to use the modifier.

The 82948 service, on the other hand, does not appear on the list as it is regarded as a moderately complex test. Consequently, according to CMS, administering the test involves slightly higher standards: in addition to the CLIA certificate, "laboratories or sites that perform these tests [also] need to ... be inspected, and must meet the CLIA quality standards described in 42 CFR Subparts H, J, K and M" (Source: https://wwwn.cdc.gov/clia/resources/testcomplexities.aspx).

For the full list of laboratory requirements, go to >https://www.ecfr.gov/cgi-bin/text-idx?SID=1248e3189da5e5f936e55315402bc38b&node=pt42.5.493&rgn=div5.