Issue link: https://viewer.e-digitaledition.com/i/1110805
Remote Physiologic Monitoring BY K YLE SUTLIFF IN A WORLD of ex pa nding tele- m e d i c i n e a n d home healthcare, c o n f i d e n c e i n r e c e i v i n g a d e - quate physicia n rei mbu rsement f o r r e m o t e patient mon itor i n g ( R PM ) ser v ices that ha s traditiona lly been less tha n ensu red may now become a reg u la r occurrence. Due to numerous factors including improved patient monitor- i n g tech nolog y a nd com mu n ication software, an aging population and the Centers for Medica re a nd Medica id Ser vices' (CMS) acknowledgement of transportation related hardships, as well as a genera l shift in patient and physi- cia n preferences towa rds preemptive ca re a nd convenience, CMS has — as of Ja n. 1 — implemented a new set of CPT codes (99453, 99454 and 99457) to guide providers and ensure they get paid for establishing, monitoring a nd providing patient instructions for remote monitoring devices. These codes offer medica l providers the ability to receive adequate reimbursement for activities like wa lking a patient through the use and care of monitoring devices, including devices measuring blood pressure, pulse oximetry, or respiratory flow rate, review of the information from sa id devices (whether daily or by programmed alert), monthly follow-ups with patients regard- ing such information, and other similar patient care and management services. Pr ior to t he new codes, R PM ser- v ices ha d been rei mbu rsable u nder the 16-year-old code 99091 (previously used for the collection and interpretation of simi la r physiolog ic data dig ita l ly s t or e d a n d t r a n s fe r r e d ). T h e n e w codes are more easily satisfied and a lso broken into one of three separate parts to more accurately ref lect how R PM ser vices are currently being provided. F i r s t , 9 9 4 5 3 pr o v i d e s r e i m b u r s e - ment for patient instr uction a nd the initia l set up of the recording equip- ment. Code 99454 covers successive monitoring of the devises, and, fina lly, code 99547 allows for reimbursement of interactive communications between the patient and qualified health profession- als regarding information gathered from the devices without the requirement of a face-to-face interaction. A d d i t i o n a l l y , w h i l e t h e t e r m "qua lified hea lth professiona ls" under code 99091 included physicia ns a nd "si m i l a r prov ider s ," t he new code s expa nded who is able to provide ca re, including clinica l sta ff, such as regis- tered nurses, a nd even some medica l assista nts depending on the scope of State law and supervision requirements. This ease of use was further expanded as of Ma rch 15, when CMS released a technica l clarification, which removed a sentence from the Ja nua r y publica- tion which prohibited billing for these codes when "f ur nished by au x i lia r y personnel incident to a practitioner's professiona l services." The correction expressly states that such "incident to" billing is permitted given the appropriate direct super vision norma lly required for such billing. The new codes are also more easily met in that code 99091 required providers to track their ser vices on a revolving 30-day period and provide a minimum of 30 m i nutes of R PM ser v ices per a 30-day period. Services under the new codes are tracked on a simple month-to- month basis and only require 20 minutes of RPM services to seek reimbursement. Even with all these improvements, two issues that are not discussed in the Final Rule but should nonetheless be complied with are; (i) obtaining patient consent, which was required under code 99091 and absent contradiction from CMS should be expected to apply to the new codes, and (ii) all other Medicare service requirements including applicable patient co-pays. Finally, we are still waiting on clari- fication from CMS regarding the kinds of technology that can be utilized under the new codes. For example, safe prac- tice absent clarification would be to rely exclusively on equipment meeting the FDA definition of "medical devices," however, many advocates are hoping for CMS to expand the scope of RPM devices to include even more convenient technology such as the patients' smartphones or Fitbits. As of now, CMS has only responded that they "plan to issue guidance to help inform prac- titioners and stakeholders on these issues." In su m ma r y, prov iders cu r rent ly monitoring their patients, using existing chronic care management codes, which can be billed concurrently with R PM codes, and those seeking to expand into RPM services should familiarize itself with these new codes and keep their eyes open for CMS guidance which might give rise to a variety of new ways to expand their practice and allow for more con- venient patient care. Kyle Sutliff is an associate at CCBLaw, a boutique law firm focused on providing counsel to physicians and other health- care professionals. He can be reached at 315-477-6261 or ksutliff@ccblaw.com. n In Light of Recent CMS CPT Codes and Clarifications 1 0❱❱❱❱❱ L E G A L E A S E