Procedure-Specific Billing
Specialized Billing for Every Endocrinology Service
Each endocrinology service line carries its own coding complexity, DME authorization requirements, and payer documentation standards. ProtoMed's certified team handles every service correctly, capturing the full reimbursement value of your diabetes management, thyroid care, device billing, and care management programs.
Diabetes ICD-10 & HCC Coding
Diabetes is the highest-volume diagnosis in endocrinology, and ICD-10 specificity directly affects HCC risk adjustment revenue on Medicare Advantage patients. Documenting "diabetes mellitus" without specifying type, complications (nephropathy, neuropathy, retinopathy), insulin dependence, or current HbA1c status leaves risk-adjustment revenue uncaptured. We ensure every diabetes encounter is coded with full ICD-10 specificity, protecting both reimbursement accuracy and HCC risk score integrity across your entire diabetic patient panel.
Thyroid Ultrasound & FNA Billing
When thyroid ultrasounds and FNA biopsies are performed in-office with physician interpretation, each service must be correctly billed using technical and professional component modifiers or the global code, depending on who owns the equipment and who performs the interpretation. Ultrasound-guided FNA requires a separate imaging guidance code alongside the biopsy code. We accurately code every thyroid imaging and FNA encounter, apply the correct component modifiers, and ensure the documentation supports both the imaging and the biopsy claim.
CGM Billing & Authorization
Continuous glucose monitor billing involves device-specific HCPCS codes, separate codes for sensors and supplies, and prior authorization from most commercial payers and Medicare. LCD criteria require documentation of specific insulin regimen requirements and frequency of glucose monitoring. CGM supply orders must be renewed and authorized regularly to maintain ongoing reimbursement. We manage CGM initial authorization, device billing, supply code sequencing, and renewal authorizations, ensuring your patients receive their monitors and your practice receives its reimbursement.
Insulin Pump (CSII) DME Billing
Insulin pump billing requires prior authorization with documented failure of multiple daily injection therapy, physician attestation of patient training completion, and HCPCS coding for the pump and all consumable supplies. Supply codes for reservoirs, infusion sets, and other consumables must be reordered and rebilled monthly with quantity-specific HCPCS codes. We manage the complete insulin pump billing lifecycle, from initial authorization and pump device billing through monthly supply reorders, ensuring continuous reimbursement throughout the patient's pump therapy.
CCM & Care Management Billing
Endocrinology practices with large diabetic patient panels qualify for significant Chronic Care Management revenue: CKD from diabetes, hypertension with diabetes, and multiple comorbidities all qualify most diabetes patients for CCM billing. Monthly time tracking, patient consent, and care plan documentation are required. We identify every CCM-eligible patient in your endocrinology panel, enroll eligible patients, manage the monthly time documentation requirements, and bill CCM services accurately to capture this recurring revenue stream.
Bone Density & Osteoporosis Billing
DEXA bone density scans require specific CPT codes based on the anatomical sites measured and must meet LCD medical necessity criteria for covered indications, including osteoporosis monitoring, glucocorticoid-induced bone loss, and fracture risk assessment. Professional and technical component billing applies when the endocrinologist interprets the study separately from the facility performing the scan. We accurately code every DEXA study, manage payer-specific coverage criteria, and ensure component billing is correctly applied for in-office versus external scan interpretation.
