Guidance for using out-of-office BPs is not new. Medical evidence and clinical guidelines published over the last decade have showcased the importance of 24-hour ambulatory monitoring as the reference standard, and self-measured blood pressure monitoring (SMBP) as an acceptable alternative for obtaining BPs to diagnose and treat hypertension.
And thanks to that abundance of research on the benefits of out-of-office BPs, the 2020 Current Procedural Terminology (CPT®) code set now includes SMBP.
Beginning Jan. 1, 2020, physician practices that educate patients to perform SMBP monitoring can submit claims using CPT codes associated with clinical services. 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. Home BP monitoring also helps patients to take an active role in the process.
“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 AMA Vice President of Health Outcomes Michael Rakotz, MD. “And the reason is that using SMBP provides more BPs over a longer period of time, which yields a more representative picture of a patient’s BP than BPs obtained during a single office visit.”
“Most importantly, the out-of-office measurements are more predictive of future cardiovascular risk than measurements taken in the office,” said Dr. Rakotz.
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to 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 the AMA and American Heart Association.
In 2020, this is how the two CPT codes will work for using SMBP to help physicians better care for their patients.
Training, patient education and device calibration
CPT code 99473 can be submitted when physician practice staff provide training, device setup and calibration of SMBP devices validated for clinical accuracy for patients, and patients are instructed to properly monitor their BP at home. This code can only be submitted once.
“Over the last 15 years, many studies indicate that up to one-half of people with hypertension report using SBMP monitors,” said Dr. Rakotz.
In addition, the 2015–2016 DocStyles survey of more than 1,500 primary care physicians and nurse practitioners suggests that close to 97% of the survey respondents reported using SMBP with their patients.
Ongoing treatment decisions
Physicians can also submit CPT code 99474 once a month for ongoing treatment decisions. This code can be used when patients and/or caregivers report their BP readings back to the practice—whether it is done electronically or in person with a SMBP recording log—which then allow the physician to make ongoing treatment decisions based on the average of the patient’s BP readings.
“The goal is to get 28 readings over seven days, with a minimum of 12 readings, and have them shared with their provider,” said Dr. Rakotz. “A provider will take the average BP, document it in the patient’s medical record and communicate a plan of care back 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 to use, and to make it easier for patients to communicate their results back to their physicians, who will use the BP readings to make more informed clinical decisions.”
For a better understanding of the latest revisions to the CPT code set, rely on the new guide, CPT® Changes 2020: An Insider's View. The 2020 CPT codes and descriptors can be imported straight into existing claims and billing software using the downloadable CPT 2020 Data File. The file contains the updated code set’s complete descriptor package, including official descriptors for consumers and physicians, and the official CPT coding guidelines.
