Endocrinology is a vital medical specialty focused on diagnosing and treating disorders related to hormones, metabolism, and the endocrine glands. From diabetes and thyroid dysfunction to adrenal and pituitary diseases, endocrinologists manage chronic and often complex conditions that require long-term care.

However, the complexity of endocrinology billing goes far beyond clinical care. Accurate CPT/ICD-10 coding, documentation of medical necessity, frequent use of labs and diagnostic tests, and evolving payer rules make billing in this field both challenging and time-sensitive.

At Progressive RCM, we provide tailored endocrinology medical billing services that reduce claim denials, increase reimbursements, and give endocrinologists more time to focus on patient care — not paperwork.

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Unique Challenges in Endocrinology Billing

1. Chronic Disease Management

Many endocrine disorders like Type 1 and Type 2 diabetes, thyroid disorders, and osteoporosis involve multiple visits, lab tests, and ongoing medication adjustments. Billing must reflect the complexity and frequency of care accurately.

2. High Lab Utilization

Endocrinologists frequently order labs for hormone levels, glucose, HbA1c, thyroid panels, and more. Some of these may be bundled or denied if not properly documented or linked to medical necessity.

3. Evaluation & Management (E/M) Coding

E/M services often require detailed documentation based on time, complexity, and decision-making. Using outdated codes or levels can lead to underbilling or audits.

4. Insulin Pump and CGM Management

Billing for insulin pump training, monitoring, and continuous glucose monitoring (CGM) involves DME codes, software data interpretation codes, and requires prior authorization in many cases.

5. In-House Procedures and Imaging

Endocrinologists may perform thyroid ultrasounds, biopsies, or fine-needle aspirations (FNA) in-office. Proper billing requires accurate modifier use and global service understanding.

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Common Endocrinology Procedures & Billing Codes

We help you code and bill for procedures like:

• CPT 99213–99215 – E/M office visits

• CPT 82947, 82962 – Blood glucose tests

• CPT 83036 – HbA1c

• CPT 84436–84443 – Thyroid hormones (T3, T4, TSH)

• CPT 96372 – Therapeutic injections (e.g., B12, insulin)

• CPT 76942 – Ultrasound guidance for FNA

• CPT 82728 – Ferritin

• HCPCS E0784, A4225 – Insulin pumps and supplies

• CPT 95250, 95251 – CGM setup and data interpretation

Correct ICD-10 pairing is critical, for example:

• E11.9 – Type 2 diabetes mellitus without complications

• E03.9 – Hypothyroidism, unspecified

• E05.00 – Thyrotoxicosis without thyrotoxic crisis

• E21.0 – Primary hyperparathyroidism

• E28.2 – Polycystic ovarian syndrome

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Our Endocrinology Billing Services

At Progressive RCM, we deliver a full suite of billing and revenue cycle management services tailored to endocrinology practices, solo or group-based.

✅ Accurate Coding and Charge Entry

Our certified coders review physician notes and convert them into clean claims using the right CPT, ICD-10, and HCPCS codes, applying modifiers (25, 59, etc.) as needed.

✅ Eligibility Verification and Prior Authorization

Before submitting claims, we:

• Check patient insurance coverage

• Verify deductibles, co-pays, and policy limits

• Secure prior authorization for injectable drugs, imaging, and CGM/DME equipment

✅ Claims Submission & Reimbursement Optimization

We submit claims within 24–48 hours using advanced claim scrubbing tools to detect errors before submission. This improves first-pass resolution rates and reduces delays.

✅ Denial Management & Appeals

If a claim is denied, we:

• Analyze the reason (e.g., lack of documentation, incorrect code, missing prior auth)

• Correct and resubmit the claim

• Appeal with supporting clinical notes if necessary

Our goal: Minimize denials, maximize cash flow.

✅ Payment Posting & A/R Management

We ensure that every payment from insurance or patients is posted accurately, and we monitor Accounts Receivable aging to keep payments flowing on time.

✅ Patient Billing Support

We generate clear, professional statements for out-of-pocket balances and assist with online payments, payment plans, and phone support for billing inquiries.

✅ Detailed Reporting & Compliance Audits

Monthly reports include:

• Reimbursement rates

• Denial trends

• Provider productivity

• Aging balances

• Coding compliance checks

We help you stay audit-ready and compliant with Medicare, Medicaid, and commercial payers.

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Why Choose Progressive RCM for Endocrinology Billing?

✅ Endocrinology Coding Experts
Our coders understand endocrine-specific procedures, chronic disease coding, insulin pump management, and E/M requirements.

✅ Chronic Care Management Support
We help practices bill for CCM (CPT 99490) and remote monitoring programs to generate recurring revenue while improving patient care.

✅ Advanced EHR Integration
We work seamlessly with systems like eClinicalWorks, AthenaHealth, Kareo, AdvancedMD, and NextGen, ensuring smooth claim flow.

✅ Transparent Communication
You get a dedicated account manager, regular updates, and 24/7 access to billing performance dashboards.

✅ Audit-Ready Billing
We stay updated with CMS, ADA, and payer policies so you don’t face penalties or recoupments.

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Key Metrics We Track for Your Practice

• First-pass claim acceptance rate

• Denial rate per payer or procedure

• Average reimbursement per CPT code

• Days in Accounts Receivable (A/R)

• Patient collection rate

• Modifier error trends

• Medical necessity documentation compliance

These insights allow us to improve revenue cycle performance over time.

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Final Thoughts

Endocrinology is a specialized field that demands an equally specialized billing solution. With complex lab orders, long-term care management, and payer-specific documentation rules, there’s no room for billing errors.

Progressive RCM provides expert endocrinology billing services that let providers focus on their patients while we handle the business side of medicine with precision and care.