AACVPR 2010 Annual Meeting Highlights & Program Information
NWCVPR is proud to have sponsored the following presentation at the AACVPR 25th Annual Meeting in Milwaukee, Wisconsin, October 7-9, 2010: "How to Develop and Implement and Institute of Community Health Research to Build Healthcare Bridges to/from the Community."
Cardiac Rehab Key Points
1) Check with your Financial / Billing Office - Cardiac Rehab needs to be listed as a "non-standard cost center"; this could lead to notable increases in payment for cardiac rehab services (upwards of $100 vs. the current $38 payment). (www.aacvpr.org<http://www.aacvpr.org/><http://www.aacvpr.org/> - go to Health & Public Policy, then click on Regulatory & Legislative Updates, for more info.)
2) Cardiac Rehab patients must attend at least 1 session per week over 36 weeks (i.e. 36 weeks is the maximum duration. The patient may take a short personal or medical leave of absence, but all sessions but be completed by the end of 36 weeks.)
3) Rehab staff must do a depression screening on all patients
4) Make sure to check with your Billing Office: they must use a KX modifier (the billing office should know what this is) for any patients continuing rehab beyond 36 sessions.
5) Can not bill for initial assessment / evaluation (can only use codes 93787 (non-monitored) and 93798 (monitored); Cardiac Rehab is a comprehensive service.
6) Cardiac Rehab patients must exercise every day that they are billed, but not every session. (I.e. you can bill for 93798 & 93797 and 93798 & 93798, and 93797 & 93797 as long as the patient does some exercise the day they are billed.
7) In order for the session to be billable, exercise must occur, but exercise duration is not specified, it is based on patient ability; however the "session" duration must be a minimum of 31 minutes, to bill for one session.
8) Rehab staff needs to make use of both codes available 93797 (non-monitored) and 93798 (monitored) NOTE: monitored and exercise are NOT synonymous.
9) Rehab staff must document what physician is supervising each day that Cardiac Rehab is in session
10) The same 6 diagnoses are covered by CMS (MI, CABG, PTCA/Stent, Stable Angina, Valve Repair/Replacement, Heart & Heart-Lung Transplant); no cardiomyopathy or CHF (yet). There is a possibility that CHF might be covered in the future.
11) Supervising physicians can not be non-physician practitioner ( NPP) in certain settings. HR 6376 addresses this issue for Critical Access Hospitals (CAH). (NPP refers to: PA-C, ARNP; See HR 6376 below).
12) Medical Director should sign ITP in CR, but can be signed by either medical director or referring physician
Information for both Cardiac & Pulmonary Rehab
1) Regarding the Individualized Treatment Plan (ITP): Each ITP must have 4 Domains (exercise, education, nutrition, psychosocial) with the following 4 Sections (assessment, intervention, re-assessment, follow-up) in the ITP, must be clearly labeled.
Pulmonary Rehab Key Points
1) Pulmonary Rehabilitation (G0424) CMS states that patients must have moderate to very severe (Stages II - IV) COPD, based on GOLD Guidelines. (www.goldcopd.org<http://www.goldcopd.org/><http://www.goldcopd.org/>)
2) Respiratory Therapy Services (G0239), use for all other diagnoses (including mild COPD, post-lung transplant & Restrictive Disease, such as Interstitial Lung Disease (ILD), pulmonary fibrosis, etc.)
3) Make sure to check with your Billing Office: they must use a KX modifier (the billing office should know what this is) for any patients continuing rehab beyond 36 sessions.
4) The limit of "72" Lifetime sessions of pulmonary rehab is for G0424 code only. The patient may attend up to 72 Pulmonary Rehab sessions total, the original 36 sessions, plus another 36 sessions, if medically necessary. You need to document medical necessity in order to use the additional 36 sessions, but they do not need to be pre-approved.
5) Medical Director must have face-to-face contact with each pulmonary rehab patient (i.e. "eyeball" the patient) at least every 30 days, while the patient is enrolled in the program
6) Rehab staff must do depression screening on all pulmonary rehab patients
7) Pulmonary Rehab patients must exercise every session in order for the session to be billable. Exercise duration is not specified, it is based on patient ability, and however the "session" duration must be a minimum of 31 minutes, to bill for one session.
8) Cannot bill for initial assessment / evaluation (comprehensive service); for moderate-very severe COPD, can only use code G0424 (Pulmonary Rehab), for all other diagnoses can use codes G0237, G0238, G0239 (Respiratory Therapy Services)
9) Rehab staff must document what physician is supervising each day that Pulmonary Rehab is in session
10) Rehab staff must clarify whether the patient is participating in pulmonary rehab or respiratory therapy services (i.e. physician, orders, initial assessment, ITP, pt consent form, etc.)
11) Medical Director must sign ITP in PR; either alone or along with referring physician
NOTE: Every attempt has been made to verify the accuracy of the information provided. If you feel that something has been listed in error, please contact the NWCVPR Secretary, Karen Edwards at karen.edwards@uhsinc.com<mailto:karen.edwards@uhsinc.com> Thank You!
Updated Information: Click Here
