Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries.

Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007 and 2010 that were reimbursed. Among 1970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 ("elevated blood pressure reading without diagnosis of hypertension") versus 28.5% of claims without this code. Among claims without an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 listed, those for the component (eg, recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25th-75th percentiles, $32.95-$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care.

White coat hypertension: addressing the 10 most important questions.

The term 'white coat' hypertension (WC-HTN) is intended to reflect the situation in which measurement of blood pressure (BP) by a health professional (often a physician in a white coat) in an office setting is found to be elevated in comparison with BP measured by a more consistent and less error-prone method such as ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM). Office BP (also sometimes called 'casual BP') has formed the basis of clinical trials that confirm meaningful reductions in MI (25 %), stroke (40 %), and heart failure (50 %) with pharmacotherapy. Nonetheless, within clinical trials, a substantial minority of patients have been determined to have WC-HTN, for which treatment is not known to be of benefit, and is hence not indicated. Clinicians continue to have a good deal of uncertainty about the definition, consequences, course, and best management of WC-HTN. The intention of this communication is to address the top priority questions about WC-HTN to enable clinicians to become more confident in its identification and management.