With the pandemic still unfolding, remote physiologic monitoring may prove to be a confusing topic for some coders. The expansion of telehealth services and a multitude of waivers as a result of the COVID-19 public health emergency (PHE) could lead CPT® coders and compliance managers into uncertain and unknown areas when it comes to this service. By reviewing the fundamentals and rationale, coders can better understand how and when to code for these services for success.
Cracking the Codes
So, what is physiologic monitoring, and what codes are used to report it? Codes 99453 and 99454 are used to report this service. What types of services does remote physiologic monitoring encompass? These are services such as:
- Weight
- blood pressure
- pulse oximetry
- or respiratory flow rates
Reporting these services occurs during a 30-day period in conjunction with the development and management of an individual’s treatment plan. Understand that in order to correctly report either of these codes, the medical device used must meet the FDA’s definition of one and collected. Even more, note that transmitted data must be digitally transmitted rather than self-reported, and it is a crucial requirement that the service be ordered by a physician or other qualified healthcare professional.
| 99453 | Remote monitoring of physiologic parameter(s) (eg, weight,blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment |
Revenue Codes: 051x, 052x, 0920
| 99454 | Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days |
Revenue Codes: 051x, 052x,0920
Intended Use of Code
So how are 99453 and 99454 utilized? Code 99453 may be used to report the setup and patient education when it comes to using the device. On the other hand, Code 99454 is billed for reporting the supply of the device for daily recording or programmed alert transmissions.
“Red Light” Circumstances
When should these codes not be reported? Codes 99453 and 99454 are not reported if monitoring is fewer than 16 days. You should not report 99453 and 99454 when these services are included in other codes for the duration of time of the physiologic monitoring service (e.g., 95250 for continuous glucose monitoring requires a minimum of 72 hours of monitoring).
Understanding Episodes of Care
Know that code 99453 details the initial work associated with onboarding new patients, equipment setup, and patient education. As such, it should be reported for each episode of care. For coding remote monitoring of physiologic parameters, an episode of care is defined as beginning when the remote monitoring physiologic service is initiated and ends with the attainment of targeted treatment goals.
Clarifying Telehealth and the PHE
Understand that remote physiologic monitoring services may be provided to patients with acute conditions as well as those with chronic conditions. However, it is imperative to note that RPM is not considered a Medicare telehealth service. It will not be subject to the restrictions imposed by the telehealth statute or waivers under the COVID- 19 Public Health Emergency (PHE). Looking into the future, CMS has proposed to make permanent the ability of auxiliary personnel such as respiratory therapists to furnish CPT codes 99453 and 99454 under a physician’s supervision beyond the PHE.
Explore more billing tips and insight for respiratory CPT coding by ordering our Coding Essentials for RT/Pulmonary Function resource.
