Wiki Diabetes Pump billing

[kiku3@ptd.net]

Hi all,
I have a request from our NP's as to how to bill: "The patient is supplying the pump, the NP’s download the pump information into connect care, interoperate the reading and adjust insulin doses when appropriate. Not sure what dx codes and visit type/procedure codes to use."

I have not had experience billing for this, any help would be greatly appreciated!

Thanks,
Sara
CPC,CCA,CPMA

 

[COelger]

Re: Diabetes pump billing

Hi Sara,
I am looking for the CPT code to use for Pump downloads done during an Office Visit, if you have that information I would GREATLY appreciate you sharing it with me. The ICD-10 code to use for the download and any pump adjustments is Z46.81 - Insulin Pump Titration. The downloads I believe are only billable if done while in the Office.

COelger

 

[dojadawn]

Diabetic coding / Pumps

I'm not 100% on my knowledge....so many changes and different ins. plans.....currently, in physician office setting, established pt. follow up CPT 99211-99215.....if it is a DM pump pt. with a sensor, you can append the 25 modifier to the above CPT and add CPT 95251 (the interpretation of personal sensor data/glucose logs)......if it is JUST a pump download and they have a sensor, u can bill 95251 alone but only so often and with specific ICD10 codes with the need for benefit verification prior to billing.......i know u can bill for extended time spent on "pt. care" but I haven't been able to find in depth information on the crazy things we COULD bill for.....I hope this helps.....any ideas on where to find info on documentation guidelines for diabetic office visit