Continuous Glucose Monitoring (CGM) Systems: Leveraging Everyday Technology to Improve Diabetes Management

However, is the coding of diabetes treatment and management captured correctly?

Diabetes mellitus (DM) affects more than 400 million people worldwide. It is a chronic disease characterized by inadequate control of blood glucose levels which affects the body’s ability to convert food into energy.

Essentially, the food you eat is broken down into sugar (glucose) and released into the bloodstream to be used as the body’s main source of energy. This rise in blood sugar causes the pancreas to release insulin, a hormone that acts as a key to allowing glucose to enter cells in the body so it can be harnessed.

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

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

As noted, people with diabetes have trouble regulating glucose. Regular blood sugar checking is important. Keeping these levels within a target range helps improve energy and mood while preventing or delaying serious health complications.

Diabetic patients should have their fingers pricked with lancets to test blood sugar several times a day. These needle sticks can be painful, often resulting in less frequent testing. Uncontrollable blood sugar levels can occur with fewer tests, leading to increased hospitalizations and decreased health outcomes.

A Continuous Glucose Monitoring (CGM) system is a compact medical system that constantly monitors blood sugar levels, essentially in real time. CGM systems allow diabetic patients to better manage their condition. There have been tremendous technological advances in blood glucose monitoring systems, representing perhaps the most significant advancement in diabetes control since the discovery of insulin!

An 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 health care provider; however, coverage does not include Medicare, Medicaid, or uninsured patients – it is for commercial payers only.

SugarBEAT, developed by British biotech Nemaura Medical, is a new technology that uses a replaceable skin patch attached to an emitter. It measures blood glucose levels noninvasively by passing a low level electrical current through the skin which extracts a sample of the interstitial fluid found just under the skin. The rechargeable transmitter sends data to the user’s phone every five minutes via Bluetooth, and readings can be monitored using an accompanying app. SugarBEAT is not yet FDA approved due to delays caused by the global pandemic. Although not available in the US, it is available in the UK and throughout the Middle East. However, be on the lookout for this new interesting and effective alternative that becomes available nationwide!

The Dexcom G6 Continuous Glucose Monitoring (CGM) System is a popular product approved in the United States. The Dexcom G6 System can improve the management and treatment of diabetes because it allows the user to view their blood glucose values ​​through a smartphone or device and receiver. The Dexcom CGM uses the continuous tracking method to monitor glucose levels. Alarms will sound on these devices when your blood sugar has reached too high or too low thresholds.

The Dexcom G6 is covered by most insurance plans and comes with a CPT code. Current Assessment and Management (E&M) codes capture DexCom Continuous Glucose Monitoring.

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

CGM Service Codes and Descriptions:

  • 95249 Personal CGM – Startup/Training

Continuous ambulatory interstitial fluid glucose monitoring via a subcutaneous sensor for at least 72 hours; patient-supplied equipment, sensor placement, hookup, monitor calibration, patient training, and record printing.

  • 95250 Professional CGM

Continuous ambulatory interstitial fluid glucose monitoring via a subcutaneous sensor for at least 72 hours; equipment provided by a physician or other qualified healthcare professional (office), sensor placement, connection, monitor calibration, patient training, sensor removal, and record printing.

  • 95251 CGM interpretation

Continuous ambulatory interstitial fluid glucose monitoring via a subcutaneous sensor for at least 72 hours; analysis, interpretation and reporting.

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

For a patient established outside a facility or office (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 use only CPT codes.

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

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

Diagnosing and coding diabetes correctly, following guidelines and paying attention to specifics, is vital for us as healthcare professionals. Most importantly, patients should be aware of advances in blood glucose monitoring technology to determine which system meets their needs to better manage their condition.

Note on programming: Hear Susan Gatehouse report this story live today on Talk Ten Tuesdays, 10 Eastern.

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