Wiki E & M Visit Increase

[Copelandbell]

Hello
I have a provider who is performing an E & M level 99213 along with 99251 (Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report). He wants to bill a higher level of the E & M service i.e. 99214 or 99215 and discard using CPT 99251. Can someone please assist me with providing an answer per CPT Guidelines.

 

[jkyles]

Hi there, it's funny because I believe these codes were created in part to give providers credit for the extra expense and work associated with the devices and the data.

So far as this issue is concerned, this is covered in guidelines for the E/M codes themselves. The E/M service reported must meet the requirements for the level based on MDM or time. No where in the guidelines does it state that the level for the E/M visit automatically increases because the provider performed another service on the same day.

 

[Copelandbell]

Good Morning and Thank you for your assistance

 

[Cynthia Hughes]

Hello
I have a provider who is performing an E & M level 99213 along with 99251 (Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report). He wants to bill a higher level of the E & M service i.e. 99214 or 99215 and discard using CPT 99251. Can someone please assist me with providing an answer per CPT Guidelines.

It sounds like the physician either feels the recording time or documentation isn't sufficient to support the 95251 service (which would support inclusion of the work in the E/M) or has realized that fee schedule rates for either 99214 or 99215 are higher than for the combination of 99213 with 95251. Because 95251 exists to specifically report the review, interpretation, and reporting of findings from the data obtained from the glucose monitor with a minimum of 72 hours of recorded data, it is not technically correct to include that work in the E/M visit. The only CPT guidance would be, "Select the CPT code of the procedure or service that accurately identifies the procedure or service performed. Do not select a CPT code that merely approximates the procedure or service provided." (Page XV of the Introduction in CPT Professional)

I hope that helps.
Cindy