A Complete Guide To Cpt Codes For Continuous Glucose Monitoring

Are you planning on starting your medical practice? Are you unsure of where to begin?

Here is a deep dive into how the medical billing system works in the healthcare world, why it is important, and the CPT billing codes required for glucose. Knowing the right codes for glucose medical billing and coding accurately for your continuous glucose monitor (CGM) devices helps to boost your billing practice and reduces the risk of any loss of revenue.

How Does Medical Billing Work?

Medical billing refers to the process of submitting a claim, such as an insurance claim, and following up on it to receive full reimbursements for the patient care services rendered. While the process of medical billing may seem daunting at first, it consists of only eight simple steps. These include:

• The registration of patients
• The establishment of financial responsibility for patient visit
• Keeping a check on the patient’s entry and exit
• Monitoring coding and billing compliance
• Preparing and transferring claims
• Keeping track of payer’s fulfillment of their financial responsibility
• Deriving patient bills and statement
• Arranging collection of the payments

Why is Medical Billing Important?

At the first glance, medical billing may seem exhausting and time-consuming, but it has many benefits that outweigh the costs. The best way to reap the benefits of medical billing without the headache of hiring or training staff to manage it in-house is to outsource it to a medical billing company. With this one task lifted off your shoulders, you may focus more on patient care and quality of service.

External medical billing leads to a reduced administrative burden on the staff. Since you are outsourcing your billing practice to a company that already has extensive experience and expertise in the field, you are more likely to reduce billing errors, enhance cash flow, and improve billing compliance. Furthermore, more secure patient data would ensure patient satisfaction and prevent denials and delays in claim reimbursements.

What is CGM?

Short for a continuous glucose monitor, CGM is a professional glucose monitoring system. This device detects trends and traces patterns in people 18 or older with either type of diabetes mellitus (DM). The CGM system requires a prescription and exists solely for the use of healthcare professionals. The readings from a CGM are only available to the healthcare practitioner who then analyzes them to give a consultation report to the patient.

The CGM helps in the detection of increased or decreased glucose levels outside of the normal range. Your doctor analyzes the trends and patterns over a specific period and makes appropriate adjustments to your treatment plan.

Billing for CGM or Continuous Glucose Monitor

CPT codes for continuous glucose monitor include the CPT code 95249, 95250, and 95251.

CPT Code 95249: Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for patient-provided equipment, hook-up, sensor placement, calibration of monitor, patient training, and printout of recording.

CPT Code 95250 – Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for physician or other qualified health care professional (office) provided equipment, hook-up, sensor placement, calibration of monitor, patient training, removal of the sensor, and printout of recording.

CPT Code 95251: Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for analysis, interpretation, and report of glucose monitoring.

CPT Codes 95249 and CPT Code 95250 are used for the technical component of continuing glucose monitoring. It covers glucose sensor placement, patient training, monitor calibration, use of a transmitter, removal of the sensor, and downloading of data.

Limitations for CPT Codes 95250 and 95251

• Minimum Reporting Time

CPT Code 95250 and CPT Code 95251 have a minimum sensor time of 72 hours. Neither of the two codes can be billed if continuous glucose monitoring (CGM) is provided for less than 72 hours.

• Reporting Frequency

CPT Code 95250 and CPT Code 95251 are limited to one report per month per patient. This is regardless of the period of professional continuous glucose monitoring (CGM). The patient could be provided CGM as many times during a month but it is always reported once during CPT coding for glucose.

ICD-10 Diagnosis Codes to Go With CPT Codes for Glucose

Here is a list of common ICD-10 diagnosis codes, which are used simultaneously with the above-mentioned CPT codes for glucose.

• 649 Type 1 diabetes mellitus (DM) with hypoglycemia, without coma
• 65 Type 1 diabetes mellitus (DM) with hyperglycemia
• 69 Type 1 diabetes mellitus (DM) with any other specified complication
• 8 Type 1 diabetes mellitus (DM) with any unspecified complications
• 9 Type 1 diabetes mellitus (DM) without complications
• 00 Type 2 diabetes mellitus with hyperosmolarity without non-ketonic hyperglycemic-hyperosmolar coma or NKHHC
• 649 Type 2 diabetes mellitus (DM) with hypoglycemia, without coma
• 65 Type 2 diabetes mellitus (DM) with hyperglycemia
• 69 Type 2 diabetes mellitus (DM) with other specified complications
• 8 Type 2 diabetes mellitus (DM) with unspecified complications
• 9 Type 2 diabetes mellitus (DM) without complications
• 00 Other specified diabetes mellitus with hyperosmolarity without non-ketonic hyperglycemic-hyperosmolar coma or NKHHC
• 01 Other specified diabetes mellitus with hyperosmolarity with coma
• 49 Other specified diabetes mellitus with other diabetic neurological complications
• 65 Other specified diabetes mellitus with hyperglycemia
• 8 Other diabetes mellitus (DM) with unspecified complications
• 9 Other specified diabetes mellitus (DM) without complication

Who is allowed to Perform and Bill CPT Code 95250?

As mentioned above, the CPT code for glucose is used to bill for all the actions that enable monitoring glucose levels. These include setting up the sensor, hooking it up, calibrating the monitor, training the patient during CGM, removing the sensor, and getting a printout for the recorded results. These services coded for may be performed by:

• Certified Diabetes Educators (CDE)
• Laboratory Technicians
• Medical Assistants (MAs)
• Nurse Practitioners
• Physician Assistants
• Physicians
• Registered and Licensed Practical Nurses
• Registered Dieticians (RDs)

Any licensed healthcare professional qualifies as someone who can perform and bill CPT code 95250. Hospital outpatient departments are usually required to bill this CPT code for glucose on a standard UB-04 claim form for the respective institutions.

Who is allowed to Perform and Bill CPT Code 95251?

The CPT Code 95251 for glucose is used to bill for the analysis, interpretation, and reporting of continuous glucose monitoring (CGM). These are accurately documented in the patient’s charts to later print professional CGM reports for the patient’s medical record. The following may bill under this code:

• Physicians
• Advanced practice healthcare practitioners (HCPs), such as nurse practitioners (NP) and physician assistants (PAs)

While CPT Code 95250 can be billed by almost any of the registered and certified staff at a healthcare facility, the billing of CPT code 95251 is quite limited. The payer and state laws vary in each state and some may not restrict billing of this code by even a registered dietician.

See Also: The Value Of Remote Patient Monitoring Medical Billing

Conclusion

With the CPT codes for glucose right at your disposal and Precision Hub as your trustee, learn to optimize your workflow with office management and claims management processes. We enable you to deliver patient-centered care and leave no stones unturned in making your healthcare facility stand out in efficiency amongst its competitors.

Whether you need consulting services or finance and accounting solutions, we are here to help you streamline your administrative processes and optimize your revenue management cycle. Contact us today and choose from our wide range of data-driven services!