Bedside Blood Glucose Monitoring In Hospitals

Coding, Classification & Reimbursement

We are a hospital and our nursing staff does bedside glucose testing using a Nova-Meter. The ladies in charge of our charge master want to attach CPT code 82947 to the charge for this on our outpatient claims. We (the coders) suggested 82962 but because it states FDA approved device for home use they insist it is not correct. We can't seem to agree on an appropriate code for a bedside finger stick blood sugar. I have looked for guidance on this situation but have had no luck. My first question is can we even charge for those bedside blood sugar checks? If we can, what is the appropriate CPT code to use? We are a hospital and our nursing staff does bedside glucose testing using a Nova-Meter. The ladies in charge of our charge master want to attach CPT code 82947 to the charge for this on our outpatient claims. We (the coders) suggested 82962 but because it states FDA approved device for home use they insist it is not correct. We can't seem to agree on an appropriate code for a bedside finger stick blood sugar. I have looked for guidance on this situation but have had no luck. My first question is can we even charge for those bedside blood sugar checks? If we can, what is the appropriate CPT code to use? Continue reading >>

Bedside Blood Glucose Testing In Critically Ill Patients

Bedside blood glucose testing in critically ill patients To earn CEUs, visit www.mlo-online.com under the CE Tests tab. 1. Define what constitutes a critically ill patient population and discuss the use of handheld blood glucose monitors in critically ill populations. 2. Discuss agencies that regulate off-label device use and identify the guidelines that laboratories must adhere to, in order to be compliant with off-label device use. 3. Recognize the characteristics of diabetes statistics as the relate to healthcare and morbidity. 4. List testing methods for diagnosing and monitoring diabetes and define the limitations with each method. Studies have demonstrated that the practice of hospital bedside blood glucose testing is a necessary and effective means of managing and monitoring glycemic control. Protocols vary by institution, but there is general consensus among providers that this process is an essential component of patient care. However, the use of handheld blood glucose meters within some critically ill patient populations has resulted in varying degrees of confusion about off-label use and potential discrepancies in results. As the most widely used option for measuring blood glucose at the point-of-care (POC), handheld meters offer the benefits of portability, ease of use, and procurement of quick results (less than 10 seconds) using small samples of capillary blood that can be obtained for frequent measurements. Testing can be performed by nurses, medical assistants, and technicians, and entails low risks of blood loss and arterial line infection. In comparison, core lab testing using arterial or venous blood involves a higher degree of complexity, along with the requirement that testing be performed by appropriately trained, qualified personnel. Under most c Continue reading >>

Clinical Benefits Automated Bedside Glucose Monitoring For Critical Care

Hyperglycemia and insulin resistance (IR) are common in patients treated in the ICU, and are associated with increased morbidity and mortality in both diabetic and non-diabetic patients.1,2,3 It is estimated that approximately 20 percent of ICU patients have pre-existing diabetes and an additional 40 to 60 percent of ICU patients suffer from stress hyperglycemia or a temporary elevation of glucose levels, with all of these patients requiring accurate glucose monitoring to maintain proper glycemic control. The association of glucose control with morbidity and mortality in ICU patients is especially pronounced in patients recovering from cardiac surgery, burns, trauma and sepsis.2,3,7,11 The availability of an accurate, automated, bedside glucose monitoring system would allow for the early detection of incidents of hypoglycemia, hyperglycemia and glycemic variability, enabling clinicians to proactively manage their patients to maintain glucose control. Todays blood glucose monitoring methods suffer from a variety of error sources that can put ICU patients at risk for insulin titration inaccuracies.4 Measurement of blood glucose concentration in ICUs is generally intermittent, with analysis performed with either point-of-care glucose meters or blood gas analyzers. Blood gas analyzers are accurate, but take considerable time, limiting the number of samples. Measurements by glucose meters are more rapid and less burdensome on nursing staff, but are often confounded by the use of capillary blood and associated error.5,6 Even the more efficient glucose meters have been shown to be a burden on nursing time.7 Sending samples to the hospital central laboratory provides highly accurate measurements, but the turnaround time makes real-time measurements impossible. Benefits of Main Continue reading >>

Bedside Cgm Boosts Glucose Control In Hospital

Bedside CGM boosts glucose control in hospital SAN DIEGO Bedside continuous glucose monitoring (CGM) with a wireless hookup to a response team allowed doctors and nurses to gain better blood sugar control in hospitalized high-risk patients with diabetes, according to research reported at the annual scientific sessions of the American Diabetes Association. Continuous glucose monitoring and wireless connections can be useful in the hospital setting, not just in the outpatient setting, said Maria Isabel Garcia, RN, of Scripps Whittier Diabetes Institute. They help us to prevent problems rather than fixing them after they happen. Normally, nurses at Scripps Mercy Hospital in Chula Vista, Calif., measure the glucose of hospitalized patients four times a day through finger sticks. But this makes it difficult to closely monitor significant swings in glucose levels, especially after patients are treated with insulin, she said in an interview. Research suggests that complications due to dangerous blood sugar levels can lead to longer hospital stays, she noted. For the study, researchers assigned 45 high-risk hospitalized patients with type 2 diabetes to be monitored by DexCom G4 CGM devices. The patients were being treated for a variety of conditions, and all were expected to be hospitalized for more than 2 days. Researchers housed the normal-sized CGM devices in toolbox-sized containers at bedside. We dont want the equipment to get misplaced if the patient has to go from room to room or if the patient is discharged and takes the equipment by mistake, Ms. Garcia said. The patients were 43-82 years old (median, 61.4 years; standard deviation, 9.8), 56% male, 73% Hispanic (with 60% preferring to speak Spanish). The mean hemoglobin A1c was 10.2% (SD, 2.3), and the mean body mass i Continue reading >>

Role Of The Diabetes Educator

2016 American Association of Diabetes Educators, Chicago, IL 1 Role of the Diabetes Educator in Inpatient Diabetes Management August 2016 Diabetes educators are a valuable asset to the interdisciplinary team and are uniquely prepared to facilitate change and implement processes and programs to improve glycemic control.19, 20 Diabetes educators play a key leadership role in creating or implementing: ï‚· interdisciplinary teams (related to quality improvement, patient or medication safety, documentation/tool development, clinical informatics & decision support) ï‚· comprehensive staff diabetes education ï‚· the collection of blood glucose data and the surveillance of outcome measurements ï‚· evidence-based hypoglycemia and hyperglycemia management order sets and protocols (as well as monitoring, tracking, and root cause analysis to prevent errors and patient harm) ï‚· individualized medication management plans within the hospital setting and for use after discharge, and ï‚· a plan of care that facilitates a smooth transition across the care settings ï‚· The diabetes educatorâ€™s responsibility as a leader or member of the interdisciplinary team includes input into patient education, identifying barriers to care, care coordination and transition, nutrition therapy, medication therapy and management, hypoglycemia management and prevention, monitoring glycemic control, and professional education.19, 21-23 All components of hospital care that affect inpatient glycemia need to be considered in initiatives to improve inpatient care.12, 17, 24-27 Diabetes mellitus is the second most common diagnosis for those discharged from hospitals among adults age 18 and older.1 Patients with diabetes are frequently hospitalized, for treatment of conditions o Continue reading >>

Point Of Care Testing - The Most Comprehensive Source Of Information Online At Pointofcare.net

The methodologies for bedside Blood Glucose testing have also changed over the recent years. The trend recently is to shift away from the photometer methods, which use light detection, toward the enzyme reactions which couple glucose concentration of the oxidation of dye that changes color. The following illustrations show the Hexokinase Photometric method and the Glucose Dehydrogenase (GDH) electrode method respectively: Glucose + ATP------Hexokinase--------- Glucose-6-phosphate + ADP NADH + Oxidized dye---------------------- NAD + Rduced dye Glucose + Fe 3+(CN)6----------------- Gluconolactone + Fe 2+(CN)6 Fe 2+ (CN)6--------------------------------- Fe 3+ (CN)6 + e- With the use of bedside blood glucose meters in the healthcare setting it is important to realize that the results from the meter do not exactly match the results obtained from the laboratory on the same specimen. Why is this true? Part of the reason is because meters display a lower accuracy and precision than the referenced laboratory instrument used. There is also a variability in operator technique. There are clinical differences between capillary versus venous specimens and whole blood versus plasma. The limitations on bedside versus laboratory referenced instruments may also affect the results in different ways. III. Clinical Issues of Blood Glucose Monitoring Back to top Regardless of where a specimen is obtained, be it venous, capillary, or arterial, the integrity of this specimen is crucial for obtaining accurate reliable results. Venous specimens should only be used on meters that are not affected by low oxygen concentrations. Those meters which use the enzyme glucose oxidase, use oxygen to react with the glucose. Therefore, these meters should not be used with venous specimens. Capillary speci Continue reading >>

Blood Glucose Monitoring

Rationale 1: To achieve an accurate reading. Untrained staff may obtain inaccurate or misleading results that can lead to incorrect management and adversely affect the patient. Rationale 2: To meet the manufacturers recommendations. Rationale 3: Children with Hyperinsulinism should not have blood glucose of less than 3.5mmol/L without intervention as are unable to produce alternative fuel sources such as ketones and are therefore at high risk of brain damage ( Hussain et al 2007 ). A lower level of 3.0mmol/L ( Campbell 2008 ) may be accepted for children with other conditions before intervention but the named consultant for individual patients must direct this. Rationale 4: To initiate appropriate intervention and management. Rationale 5: To promote involvement and enable partnership in care. Rationale 6: Monitoring is necessary for dose adjustment. Rationale 7: To avoid blood glucose levels rebounding above and below normal levels as a result of change to rates and subsequently a rapid change to glucose administration. Rationale 8: To initiate appropriate intervention and management. Rationale 9: To exclude meter error and incorrect results. Rationale 10: To obtain informed consent. Rationale 13: To promote involvement and enable partnership in care. Rationale 14: To minimise the risk of cross infection. Rationale 15: To avoid affecting the pincer grip and fine motor skills. Rationale 16: To prevent damage to underlying structures, e.g. nerve endings ( Jain et al, 2001; Naughten, 2005 ). Rationale 17: Continued use of the same puncture site can lead to the area becoming sore and the development of calluses ( Naughten 2005 ). Rationale 18: To prevent pain and tissue damage ( Naughten 2005 ). Rationale 19: Alcohol toughens the skin when used frequently. Rationale 20: Al Continue reading >>

Improving Inpatient Glycemic Control | Journal Of Hospital Medicine

Diagnostic and treatment algorithm for sleep in hospitalized medical patients. In this beforeafter study, we found that a multifaceted intervention consisting of a subcutaneous insulin protocol, focused education, and an order set built into the hospital's CPOE system was associated with a significantly higher percentage of glucose readings within range per patient in analyses adjusted for patient demographics and severity of diabetes. We also found a significant decrease in patientday weighted mean glucose, a marked increase in appropriate use of scheduled nutritional insulin, and a concomitant decrease in sliding scale insulin only regimens during the postintervention period. Moreover, we found a shorter length of stay during the postintervention period that persisted after adjustment for several clinical factors. Importantly, the interventions described in this study require very few resources to continue indefinitely: printing costs for the management protocol, 4 hours of education delivered per year, and routine upkeep of an electronic order set. Because this was a beforeafter study, we cannot exclude the possibility that these improvements in process and outcome were due to cointerventions and/or temporal trends. However, we know of no other interventions aimed at improving diabetes care in this selfcontained service of nurses, PAs, and hospitalists. Moreover, the process improvements, especially the increase in scheduled nutritional insulin, were rather marked, unlikely to be due to temporal trends alone, and likely capable of producing the corresponding improvements in glucose control. That glucose control stopped improving after hospital day 3 may be due to the fact that subsequent adjustment to insulin orders occurred infrequently and no more often than prior Continue reading >>

Nova Statstrip Glucose Meter Training For Glucometer Operators

A Self-Study Packet for The Johns Hopkins Hospital Point-of-Care Testing Program Â©copyright 2015 Johns Hopkins Hospital All rights reserved Overview and Objectives This module provides an introduction to the JHH policy for performing bedside blood glucose monitoring. At the conclusion of the module the learner will be able to: State training and maintenance of competency requirements with point of care testing ( POCT ) for blood glucose Define indications for blood glucose monitoring Identify how to perform a blood glucose test using the Nova StatStrip Glucose meter State procedure for obtaining capillary, venous, neonatal, and arterial blood specimen for glucose POCT Identify limitations of POCT Define operator responsibilities with POCT Training and Competency Only those operators who have completed training and have demonstrated competency may perform POCT blood glucose testing. The Training program will consist of: Attending a defined in-service session on the glucose meter. Passing a written examination Demonstrating competence through the proper performance and interpretation of quality control. Maintaining competency: Annual online education Perform 2 levels of QC once a year Reasons for Point of Care Blood Glucose Monitoring On-going management of blood glucose in patients with diabetes Rapid detection of extreme blood glucose concentrations in patients who: are in a coma have symptoms that suggest hypoglycemia or hyperglycemia Monitoring of patients: who have diabetes who are receiving Parenteral Hyperalimentation who are receiving medications which affect blood glucose concentration after liver or pancreas operative procedures with post-op or post procedure elevations in glucose secondary to stress with infection undergoing renal dialysis hyperglycemia Â P Continue reading >>

Role Of Nursing In The Continuum Of Inpatient Diabetes Care

Overview Hyperglycemia in the hospital setting Common Costly Associated with poor clinical outcomes Glycemic targets have been modified 140-180 mg/dL Insulin is the treatment of choice to manage hyperglycemia Hyperglycemia management requires multidisciplinary collaboration Nursing role is critical throughout hospitalization * Importance of Nursing Care for Improving Glycemic Control 24-hour coverage by nursing Nursing often coordinates, and is aware of, the multiple services required by patient Travel off unit, (eg, physical therapy, X-ray) Amount of food eaten (carbohydrates) Patientâ€™s day-to-day concerns Order changes (by various providers) * Moghissi ES, et al. Endocrine Pract. 2009;15:353-369. Umpierrez GE, et al. J Clin Endocrinol Metab. 2012;97:16-38. Inpatient Glycemic Control Recommendations Identify elevated blood glucose in all hospitalized patients Implement structured protocols for control of blood glucose throughout the hospital Glucose targets: ICU: 140-180 mg/dL for most patients Noncritically ill: Fasting BG <140 mg/dL; random BG <180 mg/dL Create educational programs for all hospital personnel caring for people with diabetes Plan for a smooth transition to outpatient care with appropriate diabetes management * TPN, total parenteral nutrition. Carter L. Oklahoma Nutrition Manual, 12th ed. Owasso, OK: Oklahoma Dietetic Association; 2006. Factors Affecting Blood Glucose Levels in the Hospital Setting Increased counter-regulatory hormones Changing IV glucose rates TPN and enteral feedings Lack of physical activity Unusual timing of insulin injections Use of glucocorticoids Unpredictable or inconsistent food intake Fear of hypoglycemia Cultural acceptance of hyperglycemia * Glucose Control Deteriorates During Hospitalization Hyperglycemic Influences Continue reading >>

Diabetes: Hospitals Ramping Up Inpatient Care

Diabetes Framing the Issue Diabetes is common in the hospital. The condition was a primary or secondary diagnosis in more than 5.3 million hospital discharges in 2010. The disease puts patients at higher risk of serious complications in the hospital. These include dangerous blood sugar levels, falls, infections and pressure ulcers. Medicare penalties for excess readmissions and high rates of health care-acquired conditions make blood sugar control a high priority for hospitals. Diabetes as a principal or secondary diagnosis can increase patient lengths of stay, which decreases hospital revenue. The mean length of stay for diabetic patients was 5.3 days in 2008, compared with 4.4 days for patients without the condition. At any given time, one-third or more of patients in most hospitals have high blood sugar, typically caused by diabetes. These patients are at higher risk of serious complications: infections, falls, pressure ulcers and harmful or even deadly high or low blood sugar swings. Medicare payment penalties for having high rates of health care-acquired conditions and for excess readmissions mean that hospitals must have systems in place to manage patients' blood sugar or run the risk not only of bad patient outcomes, but also financial losses. "What hospitals should be doing is identifying diabetic patients when they come in and doing whatever they can to prevent that patient from getting any kind of hospital-acquired issue," says Hazel R. Seabrook, a managing director at Huron Consulting Group, Chicago. But inpatient stays have to include more than blood sugar management. "Hospitals should also do appropriate discharge planning for diabetic patients so the patient gets discharged to the next care setting with the right education and the right follow-up care, so Continue reading >>

Glucose Testing In Hospital Environments

In critical care settings, tight glucose control is not just for diabetics Hypoglycemia and hyperglycemia may be complications of insulin therapy for patients in an intensive care unit (ICU). In the 1990s, several sentinel studies demonstrated the need for tight glycemic control for diabetic patients in critical care settings. The studies pointed to a correlation between variability in blood glucose levels and patient morbidity and mortality. Studies headed by Anthony P. Furnary, MD, of St Vincents Hospital, Portland, Ore, led to the development of what is now referred to as the Portland Diabetes Protocols for tight glycemic control.1,2 Furnarys publications were among the earliest to present the value of proper glycemic management for diabetic patients undergoing cardiothoracic surgical procedures such as coronary artery bypass graft surgery. Following the research done by Furnarys group, Greet Van den Berghe, MD, an intensive care specialist at the University Hospital of Katholieke Universiteit Leuven, Belgium, published findings on the application of intensive insulin therapy for critically ill patients in the New England Journal of Medicine.3 Those two researchers took the lead in the use of insulin titration for surgical intensive care patients. Not long after the Furnary and Van den Berghe studies were published, commercial in vitro diagnostics companies began to demonstrate the ability of their point-of-care (POC) blood glucose meters to help in achieving tight glycemic control. However, most of those devices were a variation of products initially developed for glucose self-monitoring, with additional communication and information technology add-ons required for reporting and recording patient test results in a hospital setting.(For more information, see the com Continue reading >>

Bedside Glucose Monitoringis It Safe? A New, Regulatory-compliant Risk Assessment Evaluation Protocol In Critically Ill Patient Care Settings*

Inpatient glycemic management (IPGM) has become widely accepted as a standard of care ( 1 ). Proper glucose measurement is key to safe and effective IPGM ( 2 , 3 ). Bedside glucose monitoring with blood glucose meters is an essential component of IPGM, but has been shown to create confounding analytical and clinical factors ( 4 , 5 ). This occurred when self-monitoring blood glucose meters (SMBG) designed for diabetic patient self-use migrated into the hospital. Subsequently, numerous studies demonstrated confounding factors affecting clinical outcomes in acute care settings. This multicenter observational study is the first to present an algorithm combining four statistical tools to evaluate the analytical and clinical accuracy of a blood glucose monitoring system (BGMS) in critical care patient settings. In the 1990s through the first decade of the new millennium, glycemic management programs were developed, implemented, and studied to determine the clinical outcome of glycemic control through IV intensive insulin therapy (IIT) in critically ill patients ( 69 ). The initial outcomes of these glycemic management programs were profound; they significantly reduced postsurgical infections, blood transfusion, acute kidney injury, polyneuropathy, ICU length of stay, and in-hospital mortality ( 68 ). Unfortunately, follow-up studies reported increased risk for hypoglycemia with an associated enhanced mortality in critically ill patients who received IV IIT ( 1012 ). Central to these adverse events was the unreliability and lack of standardization of glucose measurement. Historically, the quality of glucose measurement for diabetic patients was assessed using measurement validation protocols established by regulatory and standards agencies in cooperation with manufacturers, Continue reading >>

Bedside Glucose Monitoring | Uamshealth

Home / Why UAMS / Quality / Quality Health Library / Diabetes /Bedside glucose monitoring Bedside glucose monitoring fantasktic 2017-03-27T12:33:08+00:00 Persons with diabetes who are hospitalized often have fluctuations in blood glucose levels due to illness, stress, changes in diet and activity, and changes in medications and treatments. These changes require frequent testing so that the blood glucose can be as tightly controlled as possible. The American Diabetes Associations Standards of Medical Care in Diabetes-2007 recommend Point of Care Testing (POCT), or bedside glucose monitoring, for persons with diabetes who are hospitalized. Bedside glucose monitoring requires a finger-prick capillary blood sample, which is placed on a reagent strip and then into an electronic meter. Within a few seconds the current blood glucose level is available. Most people with diabetes monitor blood glucose at home using similar equipment, but to ensure safety for hospital equipment, additional quality assurance checks are needed. A complete quality assurance program, usually directed by a laboratory professional, assures that the equipment and processes meet strict laboratory standards, even though they are being used outside of the lab ( Diabetes Care, February 2004: 27(2); 553-591 ; American Society for Clinical Laboratory Science, Point of Care Position Paper; College of American Pathologists, (CAP) Laboratory Accreditation Program ). Continue reading >>

Only Glucose Meters Accurate Enough To Be Fda-cleared For Use With All Patients, Including Critically Ill

ONLY glucose meters cleared by the FDA for use with all patients, in all professional healthcare settings, including critical care • Eliminates interference which cause incorrect glucose readings and misdosed insulin. ONLY glucose meters that are CLIA-waived for use with all patients including critically ill • Nursing and point-of-care (POC) operators can perform testing with all patients Accuracy proven in study of 1,698 critically ill patients with over 257 medical conditions • Improved accuracy results in fewer insulin misdoses and better outcomes for critically ill patients Excellent correlation to IDMS traceable laboratory methods • ONLY glucose meter proven to have no known clinical interferences • Tested over 8,000 medications with no interferences ONLY glucose measurement technology specifically designed for hospital use Wireless meter connectivity to LIS/HIS with StatStrip Glucose New breakthrough for use with critically ill In 2014, after an extensive, nearly four-year project conducted at five major university medical centers, Nova Biomedical achieved a major breakthrough in intended use for the StatStrip Glucose Hospital Meter System. In response to Nova’s 510(k) submission (K132121), the U.S. Food and Drug Administration (FDA) cleared StatStrip Glucose for use throughout all professional healthcare settings including critical care. It is the only glucose meter to obtain this clearance. “This device [StatStrip Glucose] provides an important public health resource for critically ill hospitalized patients, who often have conditions or are taking medications that can cause incorrect blood glucose reading. It is important for manufacturers of glucose meters used in hospitals to design and test their devices for use in all hospitalized patients.”1 Continue reading >>