Telemedicine and Coding for Remote Blood Pressure Monitoring

Telemedicine has grown rapidly because it allows the remote delivery of healthcare services during the pandemic. Telemedicine tends to lower healthcare costs, expand the patient database, and offer flexible working conditions for physicians and health care providers. It reduces physical office hours and saves overhead costs, like payroll for hourly employees, utilities, and other various expenses associated with an office being open.

Remote Patient Monitoring is a key component of Telemedicine. It allows the physician and the patient’s care team to get real-time data thereby enabling communication without an in-person appointment.

The Center for Medicare and Medicaid Service (CMS) introduced new Current Procedural Terminology codes for Remote Patient Monitoring (RPM) and it has been recognized by the Center for Medicare and Medicaid Service (CMS) as an integral part of the future of the healthcare system. The Center for Medicare and Medicaid service has realized that the quality of patient care can be boosted with the implementation of the technology and therefore re-evaluated their Current Procedural Terminology codes for providing these types of healthcare services.

CMS introduced new codes for remote patient monitoring in 2019. The introduced codes were designed to accurately reflect the steps in implementing and utilizing Remote Patient Monitoring (RPM) as a patient care tool in the current healthcare system. The Remote Patient Monitoring includes Blood Pressure, Weight, Pulse Oximetry, Respiratory flow rate, however they are not limited to these. Also, the Remote Patient Monitoring instruments are various medical devices that monitor, heart rate, vital signs, glucose levels, sleeping patterns.

Remote Patient Monitoring (RPM) enables patients to be involved in their own care by giving them entitlement to their health information in real-time. Also, patients with certain chronic conditions are able to create treatment and nutrition plans, access medication guides, and also integrate date from wearables like continuous glucose monitors and fitness monitors with their physicians. Physicians are also able to use their patient information to have a better understanding of their patient’s health conditions as well as developing a care plan that suits their lifestyles.

NEW CHRONIC CARE REMOTE PHYSIOLOGIC MONITORING CODES

The new current procedural codes provide an additional reimbursement opportunity for remote monitoring of patient health. The codes for remote physiologic monitoring include the following:

Healthcare Common Procedural Coding System (HCPCS) code G2010

Current Procedural Terminology (CPT) code 99453

Current Procedural Terminology (CPT) code 99454

Current Procedural Terminology (CPT) code 99457

HEALTHCARE COMMON PROCEDURAL CODING SYSTEM (HCPCS) CODE G2010

The code G2010 was developed by the Center for Medicare and Medicaid Services (CMS). It is a virtual communication code. Remote evaluation of recorded video and or images submitted by an established patient (e.g store and forward), which include interpretation with follow-up with the patient within 24 working hours, not originating from a related evaluation and management (E&M) service provided within the previous seven days nor leading to an evaluation and management service (E&M) or procedure within the next 24 working hours or soonest available appointment.

CURRENT PROCEDURAL TERMINOLOGY (CPT) CODE 99453

Remote monitoring of physiologic parameter(s) (e.g blood pressure, weight, pulse oximetry, respiratory flow rate) and it also includes initial set-up and patient education on the use of equipment.

For Primary Care Providers (PCP): Current Procedural Code 99453 offers reimbursement for the work associated with Remote Patient Monitoring (RPM) service with the following onboarding a new patient into Remote Patient Monitoring (RPM) service and also setting up the medical device and educating the patient on how to use the medical equipment.

CURRENT PROCEDURAL TERMINOLOGY (CPT) CODE 99454

Remote monitoring of physiologic parameter(s) (e.g blood pressure, weight, respiratory flow rate, pulse oximetry) includes initial device(s) supply with daily recording(s) or programmed alert(s) transmission, for every 30 days.

Current Procedural Terminology code 99454 offers reimbursement for providing the patient with a Remote Patient Monitoring (RPM) equipment for 30 days. The Current Procedural Terminology Code 99454 can also be billed each 30 days. The average Medicare payment from the Center for Medicare and Medicaid service (CMS) for these services is $64.15.

CURRENT PROCEDURAL TERMINOLOGY (CPT) CODE 99457

Remote physiologic monitoring treatment management services, 20 minutes or more clinical physician, staff, or other qualified health care professional time in a monthly calendar requiring interactive communication with the patient/caregiver during the month.

The center for Medicare and Medicaid Services will reimburse for clinical staff time that contributes toward monitoring data including interactive communication such as phone calls, email, and text messages.

REMOTE BLOOD PRESSURE SELF-MONITORING CODE

The two new Current Procedural Terminology (CPT) codes assigned for Blood Pressure Self-monitoring are Code 99473 and 99474.

The first Current Procedural Terminology (CPT) Code 99473 is assigned for self-measured blood pressure using a device validated for clinical accuracy. Patient education and training and device calibration.

The second Current Procedural Terminology (CPT) code 99474 is for separate self-measurements of two readings one minute apart, twice daily over 30 days with a minimum of 12 readings, collection of data reported by the patient and caregiver to the physician or other health care professional, with the report of average systolic and diastolic pressure and subsequent communication of treatment plan to the patient.

The two current procedural codes for self-measurement blood pressure state that services are related to self-measured blood pressure and also the device involved must be validated for clinical accuracy.

View all Articles by: Melissa Clark, CCS-P