Chronic disease, devices and data
Endocrinology practices manage long-term conditions — diabetes, thyroid disease, osteoporosis, pituitary and adrenal disorders — with frequent follow-up visits, device data and expensive medications. Revenue depends on capturing the work done between visits (glucose data review), coding diagnoses with full specificity, and getting drug and device approvals in place before patients run out.
Continuous glucose monitoring
| Code | Service | Limits |
|---|---|---|
| 95249 | Start-up and training for a patient-owned CGM, at least 72 hours of data | Once per period the patient owns the receiver |
| 95250 | Practice-owned (professional) CGM, sensor placement, data recording and printout | Generally once per month |
| 95251 | Analysis, interpretation and report by the physician or qualified practitioner | Generally once per month; no face-to-face visit required |
An E/M visit on the same day as 95249 or 95250 needs modifier 25 and separate documentation, and the CGM codes cannot be combined with certain remote monitoring codes for the same data. Payer frequency rules vary, so they are set per plan.
Diabetes education and nutrition therapy
- Diabetes self-management training (G0108 individual, G0109 group) is billed by an accredited program under Medicare rules, with set hours in the first year and follow-up hours after.
- Medical nutrition therapy (97802–97804) by a registered dietitian is covered by Medicare for diabetes and kidney disease with a referral.
- Both services have yearly hour limits, so hours used are tracked per patient.
Thyroid, bone and injectable drugs
Thyroid ultrasound (76536) and fine-needle aspiration biopsy (10005–10012, coded by imaging guidance with first lesion and each additional lesion) are common office procedures; the guidance is included in the FNA codes. Bone density testing (77080) has frequency limits — generally every 24 months for Medicare unless medically necessary more often — and injectable osteoporosis drugs are billed by HCPCS code and units with the administration code, after prior authorization.
Diagnosis coding and drug coverage
Diabetes codes combine the type of diabetes with its complications (for example kidney, eye or nerve complications) and long-term drug use such as insulin, so every documented complication should be captured. GLP-1 and similar drugs usually require prior authorization; coverage depends on the indication — Medicare Part D, for example, excludes drugs used only for weight loss. See prior authorization services.