Open Forum

We are working to standardize our clinical staff workflows for obtaining CGM reports and provider reviewing. If your clinic has a process in place i would love to know :

1) How much of the report is downloaded for interpretation? 

We are looking at utilizing the Overview/Summary pages (which include: Avg glucose, GMI, Time in Range, Days of data and a graph of daily averages) vs downloading full 90 day reports (which can be 5o pages or longer). 

My provider says the overview and summary page is sufficient to interpret the patients compliance and overall status, but my coder wants a report in its entirety. 

Is there a common ground between coders and providers? 

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Addie Lowe MSN RN
Covenant Medical Group
Kingstree SC
atomlin2@covhlth.com
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From what I read about CPT 95251, "Ambulatory continuous glucose monitoring of interstitial fluid via a subcutaneous sensor for minimum of 72 hours; analysis, interpretation, and report", the definition states minimum of 72 hours of data are required, and this code cannot be billed more than once per month. https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/coding-remote-patient-monitoring-continuous-glucose-monitoring.html

Might be helpful to hear why the coder wants more data than that, i.e., have there been denials for some reason? 

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Leslie McDowell ANP-BC DNP RN
Northwest AHEC/Wake Forest Univ Sch of Med
Winston Salem NC
(336) 972-7852
ANP-BC DNP RN
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