Diagnosis | Blood pressure check |
---|---|
ICD-10 | Z01.30 Encounter for examination of blood pressure without abnormal findings |
CPT | 99211 Established patient E/M office visit Incident-to policy applies |
The specific amount you’ll owe may depend on several things, like:
The ICD-10-CM is a catalog of diagnosis codes used by medical professionals for medical coding and reporting in health care settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates.
Sara Berg, MS
Encounter for examination of blood pressure without abnormal findings. Z01. 30 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
The two new codes—99473 and 99474—support home blood-pressure monitoring, which provides useful information physicians can use to better diagnose and manage hypertension.
93784ABPM CODINGCPT codeProcedure93784Ambulatory blood pressure monitoring, utilizing report- generating software, automated, worn continuously for 24 hours or longer; including recording, scanning analysis, interpretation, and report.93786Recording only (reported on the date monitoring is completed)2 more rows
R03. 0: Elevated blood-pressure reading, without diagnosis of hypertension.
ANSWER: You may bill CPT code 99211 for a blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure. CPT code 99211 does not require the presence of the physician.
Automatic Blood Pressure Monitor with Cuff Blood pressure equipment is considered durable medical equipment (“DME”).
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare: When you provide both the technical and professional components, use code 93784.
I10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM I10 became effective on October 1, 2021. This is the American ICD-10-CM version of I10 - other international versions of ICD-10 I10 may differ.
Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as nursing staff, medical assistants, or technicians, who must document the visit just as a provider would. Common examples include hypertension or wound checks by a nurse or medical assistant.
0 for Elevated blood-pressure reading, without diagnosis of hypertension is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .
ICD-10 code I95 for Hypotension is a medical classification as listed by WHO under the range - Diseases of the circulatory system .
uncontrolled hypertension. Code I10 for HTN is assigned when HTN is described as essential, benign or malignant as well as when HTN is not otherwise specified (NOS). hypertensive heart disease: I11. 0 (with heart failure) and I11.
And, as mentioned, the diagnosis code is R03.0. Of course, there are other indications for this test, this article discusses only the change in range for white coat syndrome. The test is still covered for hypertensive related disorders.
Neither the CPT ® nor the ICD-10 coding has changed , only the eligibility, expanding the covered indications. These are copied from the CMS document into the post, below.
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:#N#For beneficiaries with suspected white coat hypertension, which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm Hg but less than 160 mm Hg or diastolic blood pressure greater than 80 mm Hg but less than 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are <130/80 mm Hg.#N#For beneficiaries with suspected masked hypertension, which is defined as average office blood pressure between 120 mm Hg and 129 mm Hg for systolic blood pressure or between 75 mm Hg and 79 mm Hg for diastolic blood pressure on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥130/80 mm Hg.
Abnormal blood-pressure reading, without diagnosis 1 R03 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail. 2 The 2021 edition of ICD-10-CM R03 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of R03 - other international versions of ICD-10 R03 may differ.
The 2022 edition of ICD-10-CM R03 became effective on October 1, 2021.
05/2020 - The purpose of this change request is to inform contractors that for dates of service on and after July 2, 2019 , CMS will cover Ambulatory Blood Pressure Monitoring for the diagnosis of hypertension in Medicare beneficiaries under updated criteria. ( TN 10073 ) (CR11650)
capable of producing standardized plots of BP measurements for 24 hours with daytime and night-time windows and normal BP bands demarcated; and,
For beneficiaries with suspected white coat hypertension, which is defined as average office BP of systolic BP > 130 mm Hg but < 160 mm Hg, or diastolic BP > 80 mm Hg but < 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit, and with at least two BP measurements taken outside the office which are < 130/80 mm Hg.
Ambulatory Blood Pressure Monitoring ( ABPM) is a diagnostic test that allows for the identification of various types of high blood pressure (BP). ABPM devices are small portable machines that are connected to a blood pressure cuff worn by patients that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities, including sleep. The recording is interpreted by a physician or non-physician practitioner, and appropriate action is taken based on the findings. Diagnosis and treatment of high BP is important for the management of various conditions including cardiovascular disease and kidney disease.
For beneficiaries with suspected masked hypertension, which is defined as average office BP between 120 mm Hg and 129 mm Hg for systolic BP, or between 75 mm HG and 79 mm Hg for diastolic BP on two separate clinic/office visits with at least two separate measurements made at each visit, and at least two BP measurements taken outside the office which are ≥ 130/80 mm Hg.
09/2012 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.Implementation date: 01/07/2013 Effective date: 10/1/2015. ( TN 1122 ) ( TN 1122 ) (CR 7818)
For dates of service on and after July 2, 2019, the Centers for Medicare & Medicaid Services (CMS) believes that the evidence is sufficient to determine that ABPM is reasonable and necessary for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:
Patients are taking a more active role in their blood pressure (BP) monitoring, making it easier for physicians to diagnose and manage hypertension.
99474 Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
“The new CPT codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care,” according to Harris.#N#Using SMBP provides more BP readings over a longer period, which paints a better picture of the patient’s BP history than monitoring during a single office visit. It also aids in predicting future cardiovascular risk over taking measurements once in the office.