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.