How To Use CPT Code 99091

CPT 99091 is a code used for the collection and interpretation of physiologic data, such as ECG, blood pressure, and glucose monitoring, digitally stored and/or transmitted by the patient or caregiver to a healthcare professional. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99091.

1. What is CPT 99091?

CPT 99091 is a medical billing code used to describe the collection and interpretation of physiologic data that is digitally stored and/or transmitted by the patient or caregiver to a physician or other qualified healthcare professional. This code is applicable when the healthcare professional spends a minimum of 30 minutes reviewing and interpreting the data within a 30-day period.

2. 99091 CPT code description

The official description of CPT code 99091 is: “Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.”

3. Procedure

  1. The patient or caregiver collects physiologic data using appropriate devices (e.g., ECG monitor, blood pressure monitor, glucose monitoring device).
  2. The data is digitally stored and/or transmitted to the physician or other qualified healthcare professional.
  3. The healthcare professional reviews and interprets the data, spending at least 30 minutes doing so within a 30-day period.
  4. If necessary, the healthcare professional provides feedback or recommendations to the patient or caregiver based on the interpreted data.

4. Qualifying circumstances

Eligibility for CPT code 99091 services depends on the following factors:

  • The patient must have a medical condition that requires monitoring of physiologic data, such as ECG, blood pressure, or glucose levels.
  • The patient or caregiver must be capable of collecting and transmitting the data using appropriate devices.
  • The physician or other qualified healthcare professional must be qualified by education, training, and licensure/regulation (when applicable) to interpret the data.
  • The healthcare professional must spend a minimum of 30 minutes reviewing and interpreting the data within a 30-day period.

5. When to use CPT code 99091

It is appropriate to bill CPT code 99091 when the following conditions are met:

  • The patient has a medical condition that requires monitoring of physiologic data.
  • The patient or caregiver is capable of collecting and transmitting the data using appropriate devices.
  • The healthcare professional is qualified to interpret the data and spends at least 30 minutes reviewing and interpreting the data within a 30-day period.
  • The service is not provided on the same day as an evaluation and management (E/M) service, as it would be considered part of the E/M service and not separately reported.

6. Documentation requirements

To support a claim for CPT 99091, the following information must be documented:

  • The patient’s medical condition that requires monitoring of physiologic data.
  • The type of data collected (e.g., ECG, blood pressure, glucose levels) and the devices used for collection.
  • The method of data transmission (e.g., email, secure messaging).
  • The healthcare professional’s qualifications to interpret the data.
  • The time spent by the healthcare professional reviewing and interpreting the data (at least 30 minutes within a 30-day period).
  • Any feedback or recommendations provided to the patient or caregiver based on the interpreted data.

7. Billing guidelines

When billing for CPT code 99091, keep in mind the following guidelines:

  • Some private payers may allow reporting of 99091, but most carriers consider this code not payable under the Provider Fee Schedule.
  • Review services rendered by the provider are part of the pre and/or post-service work associated with any E/M services the patient undergoes.
  • If the services described by CPT 99091 are provided on the same day as an E/M service, they should be considered part of the E/M service and not separately reported.
  • Do not report CPT 99091 in conjunction with codes 99457, 99458, and other codes listed in the CPT guidelines.

8. Historical information

CPT 99091 was added to the Current Procedural Terminology system on January 1, 2002. The code has undergone changes in its descriptor on January 1, 2013, and January 1, 2019, to reflect updates in the requirements and qualifications for healthcare professionals providing this service.

9. Similar codes to CPT 99091

Five similar codes to CPT 99091 and how they differ are:

  • CPT 99457: Involves remote physiologic monitoring treatment management services, requiring at least 20 minutes of clinical staff time per calendar month.
  • CPT 99458: Additional 20 minutes of remote physiologic monitoring treatment management services within the same calendar month as CPT 99457.
  • CPT 99374: Home health or hospice care plan oversight services, requiring 15-29 minutes of physician supervision per calendar month.
  • CPT 99375: Home health or hospice care plan oversight services, requiring 30 minutes or more of physician supervision per calendar month.
  • CPT 99487: Complex chronic care management services, requiring at least 60 minutes of clinical staff time per calendar month.

10. Examples

Here are 10 detailed examples of CPT code 99091 procedures:

  1. A patient with congestive heart failure uses a home ECG monitor to record daily readings, which are transmitted to the physician’s office electronically for review and interpretation.
  2. A patient with hypertension uses a home blood pressure monitor to track daily blood pressure readings, which are sent to the healthcare professional for analysis and recommendations.
  3. A diabetic patient uses a glucose monitoring device to capture multiple glucose readings during the month, along with a diary log of symptoms, medication, exercise, and diet, which are transmitted to the physician for review.
  4. A patient with a history of arrhythmias uses a wearable ECG monitor to record heart rhythms, which are transmitted to the healthcare professional for interpretation and potential adjustments to the treatment plan.
  5. A patient with chronic kidney disease uses a home blood pressure monitor to track daily readings, which are sent to the healthcare professional for review and potential adjustments to the treatment plan.
  6. A patient with a history of syncope uses a wearable ECG monitor to record heart rhythms during episodes of syncope, which are transmitted to the healthcare professional for interpretation and potential adjustments to the treatment plan.
  7. A patient with gestational diabetes uses a glucose monitoring device to capture multiple glucose readings during the month, along with a diary log of symptoms, medication, exercise, and diet, which are transmitted to the physician for review.
  8. A patient with a history of myocardial infarction uses a home ECG monitor to record daily readings, which are transmitted to the physician’s office electronically for review and interpretation.
  9. A patient with chronic obstructive pulmonary disease uses a home pulse oximeter to track daily oxygen saturation levels, which are sent to the healthcare professional for review and potential adjustments to the treatment plan.
  10. A patient with a history of seizures uses a wearable EEG monitor to record brain activity during episodes of seizures, which are transmitted to the healthcare professional for interpretation and potential adjustments to the treatment plan.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *