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Documentation Guidelines For
Billing CPT/HCPS 82962 on TOB 22X and 23X
CPT/HCPCS 82962 is defined as "Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use". Current Procedural Terminology 2005.
Beneficiaries in a Part A covered stay (TOB 21X) cannot be considered as residing in a home environment so CPT/HCPCS 82962 is never separately billable on TOB 21X. Those beneficiaries receiving Part B services on TOB 22X or 23X do meet the definition
of residing in a home environment. However, separate billing of CPT/HCPCS 82962 should be an exception rather than the rule.
This was an issue in Skilled Nursing Facilities in 1999, 2000 and 2001 that CMS addressed with Program Transmittals. However, the issue arose again in CERT reports for the year 2004 and created a large number of CERT errors. Data analysis was performed
by this FI to validate the problem in Arkansas and in Rhode Island. Widespread probes were then performed in an attempt to determine the extent of the problem. An audit has resulted and 100% of claims received with this billing will be reviewed by Medical
Review.
When claims are received for this billing, an ADR (Additional Documentation Request) will be sent to the provider. Listed below are the documentation requirements plus comments that detail what should be reflected in each record.
- History and Physical - Should establish the diagnosis, status of diabetic control, recent episodes of unstable blood sugars, confirmation that beneficiary is unable to self test if applicable, and any other pertinent information. (Please note, in most
cases the inability to self test does not assure coverage as it is generally considered to be included in the clinical services.)
- Consults pertaining to the status of the diabetes control
- Nurses’ Notes – Episodes of hypo or hyperglycemia; glucometer checks performed by staff and why; any physician notification by phone or fax of glucometer results; orders received or confirmation of no order changes.
- Glucometer Flow sheet or the Medication Administration Record (MAR), or Treatment Administration Record (TAR) – whatever record used to document the results: Looking for abnormal results and correlation with the nurses’ notes, physician notification
and response, confirmation of the frequency matching the order, and/or confirmation of reasons for missing entries
- All Physician orders including the initial, follow up orders and telephone orders for glucometer checks, changes in insulin orders or glucometer frequency.
- Physician contact sheet if applicable. This would be crucial when contacts are made that reflect the glucometer results were used to manage the diabetes.
- Medication Administration Record (MAR) – Checking insulin administration
- Laboratory records, both routine as well as those done to confirm abnormal glucometer results or testing done to manage the diabetes.
- Dietary records to determine if abnormal results have been addressed by all disciplines
- Itemized billing – Should some of the days be allowed, there is no way to separate the covered charges from the non covered charges without an itemized bill. In this event, the full claim will be denied if no itemized statement is included.
This list is not all inclusive and you are urged to submit any additional documentation that you feel will support the services.
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