How To Use CPT Code 93786

CPT 93786 describes the procedure for ambulatory blood pressure monitoring, specifically the recording of blood pressure readings over a 24-hour period using automated devices. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93786?

CPT 93786 is used to record blood pressure readings over a 24-hour period using automated devices. This code specifically refers to the recording of blood pressure and does not include scanning analysis, interpretation, or reporting. It is typically used to rule out white coat hypertension, where blood pressure readings are higher in a healthcare setting but normal at home.

2. Official Description

The official description of CPT code 93786 is: ‘Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; recording only.’

3. Procedure

1. The provider or a technician fits the patient with an ambulatory blood pressure monitor.
2. The patient wears the device continuously for 24 hours or longer while performing their daily activities.
3. The device automatically records blood pressure readings at intervals on software storage media.
4. The procedure focuses solely on the recording of blood pressure and does not involve scanning analysis, interpretation, or reporting.

4. Qualifying circumstances

CPT 93786 is typically used for patients with suspected white coat hypertension, where blood pressure readings are higher in a healthcare setting but normal at home. It is important to note that Medicare only covers ambulatory blood pressure monitoring for patients with white coat hypertension, and the monitoring must be done for at least 24 hours to meet coverage criteria.

5. When to use CPT code 93786

CPT code 93786 should be used when the provider prescribes ambulatory blood pressure monitoring for the sole purpose of recording blood pressure readings over a 24-hour period. It is important to remember that this code does not include scanning analysis, interpretation, or reporting. For other configurations of ambulatory blood pressure monitoring services, different CPT codes should be used.

6. Documentation requirements

To support a claim for CPT 93786, the provider must document the following information:

• Prescription for ambulatory blood pressure monitoring
• Duration of monitoring (at least 24 hours)
• Recordings of blood pressure readings at intervals
• Explanation of the purpose of monitoring (e.g., ruling out white coat hypertension)

7. Billing guidelines

When billing for CPT 93786, ensure that the procedure meets the criteria for ambulatory blood pressure monitoring and that the recording of blood pressure readings is the sole purpose. It is important to note that this code does not include scanning analysis, interpretation, or reporting. Medicare covers ambulatory blood pressure monitoring for patients with white coat hypertension, but coverage is contingent on the duration of monitoring being at least 24 hours.

8. Historical information

CPT 93786 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2020, with the updated description reflecting the use of report-generating software and automated devices for ambulatory blood pressure monitoring.

9. Examples

1. A patient undergoes ambulatory blood pressure monitoring for 24 hours to rule out white coat hypertension.
2. A provider prescribes ambulatory blood pressure monitoring for a patient with suspected high blood pressure, and the patient wears the device continuously for 48 hours.
3. A patient with fluctuating blood pressure readings undergoes ambulatory blood pressure monitoring for 72 hours to assess their condition.
4. A provider orders ambulatory blood pressure monitoring for a patient with hypertension to evaluate the effectiveness of their current medication regimen.
5. A patient with symptoms of dizziness and lightheadedness undergoes ambulatory blood pressure monitoring for 24 hours to assess their blood pressure patterns.
6. A provider prescribes ambulatory blood pressure monitoring for a patient with suspected masked hypertension, where blood pressure readings are normal in a healthcare setting but elevated at home.
7. A patient with a history of hypertension undergoes ambulatory blood pressure monitoring for 24 hours to assess the effectiveness of lifestyle modifications.
8. A provider orders ambulatory blood pressure monitoring for a patient with suspected nocturnal hypertension, where blood pressure readings are elevated during sleep.
9. A patient with suspected white coat hypertension undergoes ambulatory blood pressure monitoring for 24 hours to confirm the diagnosis.
10. A provider prescribes ambulatory blood pressure monitoring for a patient with suspected hypotension, where blood pressure readings are consistently low.