When I joined the diabetes team at Cleveland Clinic, I was excited about all of the technology including instant glucometer downloads, insulin pumps and continuous glucose monitoring systems (CGM). The other diabetes educators and I felt passionate that CGM is a great educational tool for patients to see in real time how food, medications, physical activity and stress affect their blood glucose levels. It was also apparent that the technology was underutilized at our Diabetes Center as we only had 1 nurse practitioner doing the interpretations.
I learned how to use this new technology and quickly discovered that interpreting the data was all about understanding pattern management. Instead of a typical glucometer or log where you might have 2-4 blood glucose readings per day, this provides 288 blood glucose readings per day. With so much data, it becomes easier to make medication adjustments and recommendations for lifestyle changes.
I posted on various message boards trying to gain insight from other pharmacists who were performing this service and if they were billing. Reimbursement is important since each sensor costs about $60. As it turns out, pharmacists can bill for CGM insertion which ironically offers more reimbursement than the interpretation. However, the interpretation code specifies nurse practitioner, physician assistant, or physician. Through communication with the OH State Board of Pharmacy and CMS, we learned that pharmacists in OH can legally do this within the pharmacist consult agreement and bill “incident to” the physician.
This is incredible because it has huge potential for revenue generation. But more importantly, this is a service that pharmacists can provide working at the top of their license that benefits patients. I do CGM as shared medical appointments in conjunction with a dietician and/or diabetes educator. The response from patients is overwhelming. One patient said, “This is the best thing I’ve ever done for my diabetes. I learned more from this experience than I did in the last 20 years living with diabetes.”
Diana Isaacs, PharmD, BCPS, BC-ADM, CDE
Clinical Pharmacy Specialist, Cleveland Clinic Diabetes Center
dianamisaacs@gmail.com
Section of Ambulatory Care Pharmacists Educational Steering Committee