However, is the coding for the treatment and management of diabetes being adequately captured?

Diabetes mellitus (DM) affects over 400 million people worldwide. It is a chronic disease of inadequate control of blood levels of glucose that affects the body’s ability to turn food into energy.

Essentially, the food you eat is broken down into sugar (glucose) and released into the blood to be used as the body’s primary energy source. This increase in blood sugar causes the pancreas to release insulin, a hormone that acts like a key to enable the glucose to enter the body’s cells so it can be leveraged.

Lack of insulin or the inability of glucose to enter cells causes sugar to build up in the blood, which, over time, can lead to complications.

Diabetes has many subclassifications, but the two main types of DM are type 1 and type 2. Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is typically diagnosed in children or younger adults, though it can develop at any age. With type 2 diabetes, patients’ problems begin when the cells in their body start to not respond to insulin as well as they should. This is called insulin resistance, which causes high blood sugar levels (hyperglycemia). This is the most common type of diabetes.

As noted, people with diabetes have trouble regulating glucose. Regularly checking blood glucose levels is important. Maintaining those levels within a target range helps improve energy and mood while preventing or delaying severe health complications.

Patients with diabetes have to undergo fingers pricked with lancets to test blood sugar several times a day. These needle pricks can be painful, often resulting in less frequent testing. Out-of-control blood sugars can occur with less testing, resulting in increased hospital admissions and decreased health outcomes.

A continuous glucose monitoring system (CGM) is a compact medical system that continuously monitors blood sugar levels, essentially in real time. CGM systems enable patients with diabetes to manage their condition better. There have been tremendous technological advances made in glucose monitoring systems, representing perhaps the most significant progress made in controlling diabetes since insulin was discovered!

One example of CGM technology is the FreeStyle Libre CGM, a continuous glucose monitoring system approved by the Food and Drug Administration (FDA) and manufactured by United States Medical Supply LLC. This system can be scanned with a smartphone using an app. The patient must have a prescription from a healthcare provider; however, coverage does not include Medicare, Medicaid, or uninsured patients – it is only for commercial payers.

SugarBEAT, developed by United Kingdom (UK) biotech Nemaura Medical, is a new technology that uses a replaceable skin patch attached to a transmitter. It measures blood glucose levels non-invasively by passing a low-level electric current across the skin that draws out a sample of the interstitial fluid found just below the skin. The rechargeable transmitter sends data to the user’s phone every five minutes using Bluetooth, and the readings can be monitored using an accompanying app. SugarBEAT is not yet approved by the FDA due to delays caused by the global pandemic. Though it is not available in the U.S., it is available in the UK and throughout the Middle East. However, be on the lookout for this interesting and effective new alternative becoming available domestically!

The Dexcom G6 Continuous Glucose Monitoring (CGM) System is a popular U.S.-approved product. The Dexcom G6 System can improve the management and treatment of diabetes, as it allows the user to see their glucose numbers through a smartphone or device and receiver. The Dexcom CGM uses the continuous tracking method of monitoring glucose levels. Alarms will sound on these devices when your blood glucose has reached thresholds either too high or too low.

The Dexcom G6 is covered by most insurance plans and has a CPT code associated with it. Current evaluation and management (E&M) codes capture DexCom continuous glucose monitoring.

Below are associated CPT® and E&M codes for Dexcom: 

Codes and Descriptions for CGM Services:

  • 95249        Personal CGM – Startup/Training

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.

  • 95250        Professional CGM

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified healthcare professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of the sensor, and printout of recording.

  • 95251        CGM Interpretation

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.

Evaluation and Management (E&M) Codes and Descriptions:

  • 99212-99215 

For an established patient in a non-facility or office setting (appropriate code to be determined by the office.)

There are no PCS codes associated with CGM systems, as PCS codes are for Inpatient procedures. CGM devices are worn by the patient and monitored and read by the provider in digital data for outpatient use and utilize CPT codes only.

Diabetes can be a challenge for coders, regardless of whether they are an experienced coders or new to coding diabetes, even with the instructions and guidelines in ICD-10-CM and ICD-10-PCS. There are several assumed conditions in the index of ICD-10-CM. It is essential for coders to continually reference and familiarize themselves with these assumed conditions when coding records for diabetes.

Coders should utilize the ICD-10-CM guidelines for accurate selection and sequencing of diagnosis codes for diabetes. The entire Chapter 4 Endocrine, Nutritional, and Metabolic Diseases of the ICD-10-CM code book contains codes for DM. These are combination codes that include the type of diabetes and associated complications, organized by the body system affected.

It is vital for us, as healthcare workers, to properly diagnose and code for diabetes, following the guidelines and paying attention to specifics. But most importantly, patients should be aware of the advancements in glucose monitoring technologies in order to determine which system meets their needs so they can better manage their condition.

Programming Note: Listen to Susan Gatehouse report this story live today on Talk Ten Tuesdays, 10 Eastern.

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