• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

non-face-to-face diabetes follow up provided by DM-E

DavitaPhillips03

Contributor
Messages
14
Location
San Antonio
Best answers
0
Hello All,

We have a Diabetes Educator (DM-E) on staff who sees any patient that our PCP's have referred to her for services. Our ops team is looking to have the DM-E call our patients and follow-up on their progress (diet, meds etc.) through a survey after they receive her initial face-to-face services. The coding education team has looked at the CCM codes (99490-99491) and ruled them out since DM is the only thing that the DM-E would be following. (we considered that the PCP would be able to count the survey time toward the CCM codes since they do manage all chronic conditions)

We have looked at 99453-99454, 99457 and 99091. What we found in our research is that 99457 would not qualify since CMS states that it only accounts for professional time (even though it lists staff in the code description) and "therefore cannot be furnished by auxiliary personnel incident to a practitioner's professional services." 99453-99454 seem to work only if the glucose monitors continually transmit to the MD, but this seems to count out what we are trying to bill for since the educator would not be monitoring the actual information transmitted. She is only going to be calling the patients and asking questions on their progress since their last visit with her.

We are not accredited through Medicare to use G0108 or G0109. We are currently billing her face-to-face services with 99211.
Another thing that the ops team is looking into doing is hiring an NP/PA that will also provide DM education and we were not sure how this would impact the coding either.

We are looking to bill these services as incident to under the ordering provider's credentials.

If anyone has another perspective on the guidelines or can offer another code for what we are trying to bill, we would very much appreciate it.
 

mitchellde

True Blue
Messages
13,308
Location
Columbia, MO
Best answers
0
the only code available for non face to face service where your office calls the patient would be prolonged non face to fact 99358-99359 and must be a minimum of 30 minutes. the problem is there are many payers thsat will not pay this code. you cannot use phone call codes as the patient must be the one that initiates the call, and it is not telehealth as the patient sounds like they would be at home.
 

DavitaPhillips03

Contributor
Messages
14
Location
San Antonio
Best answers
0
The telehealth codes were considered on our end also. We came to the same conclusion. It is nice to know that we are on the same page with others. Thank you for your feedback.
 
Top