New year, new self-measured CPT codes for BP

Guidelines for using external PAs are not new. Medical evidence and clinical guidelines published over the past decade have shown the importance of 24-hour outpatient follow-up as a reference standard and self-measured blood pressure control (SMBP) as an acceptable alternative for obtaining PA for diagnose and treat hypertension.

And thanks to the abundance of research on the benefits of out-of-office PAs, the current 2021 Procedural Terminology Code Set (CPT®) now includes SMBP.

As of January 1, 2021, medical practices that educate patients to perform SMBP follow-up may file claims using CPT codes associated with clinical services. The two new codes, 99473 and 99474, support home blood pressure monitoring, which provides useful information that doctors can use to better diagnose and control hypertension. Home BP control also helps patients play an active role in the process.

“The SMBP provides clinically useful information to help physicians make more accurate diagnoses and determine the need for treatment in people suspected of having uncontrolled high blood pressure based on routine office BP measurements,” said Michael Rakotz, MD, Vice President of AMA. “And the reason is that the use of SMBP provides more BP over a longer period of time, which provides a more representative picture of a patient’s BP than BP obtained during a single office visit.”

“Most importantly, out-of-office measurements are more predictive of future cardiovascular risk than in-office measurements,” Dr. Rakotz said.

WADA has developed online tools and resources created with the latest evidence-based information to help physicians help manage their patients ’high BP. These resources are available to all physicians and health care organizations as part of Target: BP ™, a national initiative co-led by WADA and the American Heart Association.

By 2021, this is how the two CPT codes will work to use SMBP to help doctors better care for their patients.

CPT code 99473 may be submitted when medical practice personnel provide training, device configuration, and calibration of SMBP devices validated for patients ’clinical accuracy and instruct patients to properly monitor their BP at home. This code can only be sent once.

“Over the past 15 years, many studies indicate that up to half of people with hypertension report using SBMP monitors,” Dr. Rakotz said.

In addition, the 2015-2016 DocStyles survey of more than 1,500 primary care physicians and professional nurses suggests that about 97% of respondents reported using SMBP with their patients.

Doctors can also send CPT code 99474 once a month to make ongoing treatment decisions. This code can be used when patients and / or caregivers report their TA readings in practice (whether done electronically or in person with an SMBP record), which allow the physician to make treatment decisions. continuous as a function of the patient’s average BP readings.

“The goal is to get 28 readings over seven days, with a minimum of 12 readings, and have them shared with your provider,” Dr. Rakotz said. “A provider will take the mean BP, document it in the patient’s medical history, and communicate a care plan to the patient.”

“These codes are designed to be used in primary care and digital transmission is not required,” he said. “This should make SMBP readings more reliable for physicians, and make it easier for patients to communicate their results to their physicians, who will use PA readings to make more informed clinical decisions.”

For a better understanding of the latest revisions to the CPT code set, see the new guide,CPT® 2021 changes: a privileged vision. 2021 CPT codes and descriptors can be imported directly into existing claims and billing software using the downloadable CPT 2021 data file. The file contains the complete descriptor package of the updated code set, including the official descriptors for consumers and physicians, and the official CPT coding guidelines.