Don’t Miss Code Notes for CGM Interpretation Codes
Question: I report 95251 when a provider evaluates the blood glucose levels of a patient with an external insulin pump. I reported this code regularly, including earlier this month for this patient, and the claim was paid. When I reported it most recently for this same patient, the claim was denied. What happened? AAPC Forum Participant Answer: While you should reach out to your payer directly for more information about a denial and their respective policies, CPT® code 95251 (Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report) may be appropriate for this continuous glucose monitoring (CGM) interpretation encounter, except for the fact the code notes say that it cannot be reported more than once per month. Your provider wants to keep on top of monitoring the patient’s blood glucose levels via regular appointments, and this can be resolved in the future by making some scheduling adjustments. Make sure your scheduling staff knows that glucose monitoring appointments cannot be scheduled in the same calendar month, even if a provider prefers to monitor a patient every 30 days. Rachel Dorrell, MA, MS, CPC-A, Production Editor, AAPC
