Allied Professionals Community of Practice

​I was wondering how practices bill if you are doing office device checks, remote monitoring for device evaluation and remote monitoring for heart failure. Our physicians bring the patients in every 6 months for a device check and do not want to change this policy. Therefore, we are billing in office every 6 months (2 times a year) and remote checks every 91 days (4 times a year). Now we are adding a heart failure clinic and the physician wants heart failure monitoring every 31 days. This seems like a lot of encounters but my understanding is that this is with in the CMS guidelines. Just wanting to get some input about this from other clinics.  Thank you.

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Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN
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You can do all of this billing as long as it within the correct time period ( 31 days and 91 days). The only problem I have seen is when someone doesn't use the right DX code for the HF portion. Out of habit they will use the same billing DX for a remote check and then get denied.

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Jennifer Robertson AD, CMA, CCDS
Seattle WA
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Original Message:
Sent: 04-11-2018 16:04
From: Mary Jo Goddard
Subject: Billing for office checks, remote device and remote heart failure

​I was wondering how practices bill if you are doing office device checks, remote monitoring for device evaluation and remote monitoring for heart failure. Our physicians bring the patients in every 6 months for a device check and do not want to change this policy. Therefore, we are billing in office every 6 months (2 times a year) and remote checks every 91 days (4 times a year). Now we are adding a heart failure clinic and the physician wants heart failure monitoring every 31 days. This seems like a lot of encounters but my understanding is that this is with in the CMS guidelines. Just wanting to get some input about this from other clinics.  Thank you.

------------------------------
Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN
------------------------------

Original Message------

You can do all of this billing as long as it within the correct time period ( 31 days and 91 days). The only problem I have seen is when someone doesn't use the right DX code for the HF portion. Out of habit they will use the same billing DX for a remote check and then get denied.

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Jennifer Robertson AD, CMA, CCDS
Seattle WA
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Remote monitoring interrogations can be billed every 91 days. In office programming codes do not interfere with the remote billing days. Make sure you utilize the programming codes which also cover you for iterative changes during the programming session. You cannot bill 2 interrogation codes together. I hope this helps!

Sent from my iPhone
Deb Halligan


Original Message------

I believe you can only bill for a device check every 91 days whether it is remote or in-office, so if 2 are in office then 2 remotes can be done. HF checks every 31 days are permissible if the patient has a heart failure diagnosis and an approved diagnostic feature like Optivol/Cardiac Compass.

 

 

John  

 

John Boettcher, M.B.A, M.Ed.

Director, UT Health EP Heart Training Program

Office: 713-486-1931

Cell: 713-829-8718

 

https://med.uth.edu/epheart/

 

 

 

2575 West Bellfort, Suite 195

Houston, TX  77054

713-486-1645 tel | 713-486-1631 fax

 

Thanks for sharing, that is a very important point. Billing for an interrogation vs. a programming session. Here is a delineation from the Medtronic website: 

Q11.M: If the patient receives an in person interrogation of their implanted pacemaker (PM) or defibrillator (ICD) (CPT® codes 93288 (PM) or 93289 (ICD) and this service is provided during a 90 day remote monitoring period for the implantable device, how does that affect billing?

A11.M: When an in person and remote interrogation of the same device during the same 90 day monitoring period is performed, the in person interrogation should not be billed. Only the remote service is billable (CPT® codes 93294 (PM) or 93295 (ICD), and 93296).1

Q12.M: If the patient receives an in person programming evaluation of their implanted pacemaker or defibrillator (CPT® codes 93279-93281 (PM) or 93282-93284 (ICD); depending on the number of active leads, and this service is during a 90 day remote monitoring period for the implanted pacemaker or defibrillator, how does that affect billing?

A12.M: When an in person programming evaluation is performed during the remote 90 day episode, the programming evaluation does not impact the 90 day monitoring period, and may be separately billed.1

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John Boettcher BA, MBA, MEd
Director, UT EP Heart Training Program
UT Health/McGovern Medical School
Houston TX
(713) 829-8718
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Original Message:
Sent: 04-12-2018 10:34
From: Debra Halligan
Subject: Billing for office checks, remote device and remote heart failure

Remote monitoring interrogations can be billed every 91 days. In office programming codes do not interfere with the remote billing days. Make sure you utilize the programming codes which also cover you for iterative changes during the programming session. You cannot bill 2 interrogation codes together. I hope this helps!

Sent from my iPhone
Deb Halligan


Original Message------

I believe you can only bill for a device check every 91 days whether it is remote or in-office, so if 2 are in office then 2 remotes can be done. HF checks every 31 days are permissible if the patient has a heart failure diagnosis and an approved diagnostic feature like Optivol/Cardiac Compass.

 

 

John  

 

John Boettcher, M.B.A, M.Ed.

Director, UT Health EP Heart Training Program

Office: 713-486-1931

Cell: 713-829-8718

 

https://med.uth.edu/epheart/

image001.png@01D3A3E4.92C5E4B0">

 

 

 

2575 West Bellfort, Suite 195

Houston, TX  77054

713-486-1645 tel | 713-486-1631 fax

 

​Thank you for everyone's input. This forum is so helpful.

------------------------------
Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN
------------------------------

Original Message:
Sent: 04-11-2018 16:04
From: Mary Jo Goddard
Subject: Billing for office checks, remote device and remote heart failure

​I was wondering how practices bill if you are doing office device checks, remote monitoring for device evaluation and remote monitoring for heart failure. Our physicians bring the patients in every 6 months for a device check and do not want to change this policy. Therefore, we are billing in office every 6 months (2 times a year) and remote checks every 91 days (4 times a year). Now we are adding a heart failure clinic and the physician wants heart failure monitoring every 31 days. This seems like a lot of encounters but my understanding is that this is with in the CMS guidelines. Just wanting to get some input about this from other clinics.  Thank you.

------------------------------
Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN
------------------------------

Based on my experience, the technical component can only be billed every 91 days so if it is already being billed along with the routine remote device check, the HF staff should only bill the prof. component, CPT code 93297.

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Robyn Abel MPA, CEPS,CCDS
Manager of EP and Non-Invasive Services
Novant Health Heart and Vascular Institute
Charlotte NC
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Original Message:
Sent: 04-30-2018 11:26
From: Mary Jo Goddard
Subject: Billing for office checks, remote device and remote heart failure

​Thank you for everyone's input. This forum is so helpful.

------------------------------
Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN

Original Message:
Sent: 04-11-2018 16:04
From: Mary Jo Goddard
Subject: Billing for office checks, remote device and remote heart failure

​I was wondering how practices bill if you are doing office device checks, remote monitoring for device evaluation and remote monitoring for heart failure. Our physicians bring the patients in every 6 months for a device check and do not want to change this policy. Therefore, we are billing in office every 6 months (2 times a year) and remote checks every 91 days (4 times a year). Now we are adding a heart failure clinic and the physician wants heart failure monitoring every 31 days. This seems like a lot of encounters but my understanding is that this is with in the CMS guidelines. Just wanting to get some input about this from other clinics.  Thank you.

------------------------------
Mary Jo Goddard BSN, RN
University Cardiology
Knoxville TN
------------------------------

Original Message------

Based on my experience, the technical component can only be billed every 91 days so if it is already being billed along with the routine remote device check, the HF staff should only bill the prof. component, CPT code 93297.

------------------------------
Robyn Abel MPA, CEPS,CCDS
Manager of EP and Non-Invasive Services
Novant Health Heart and Vascular Institute
Charlotte NC
------------------------------