Wiki Remote Patient Monitoring ; INPUT NEEDED ASAP!

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shannondouglass

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I am billing out for Remote patient Monitoring
We are having some confusion as to the wording "calendar month" vs. 30 days
I advised that a calendar month should be used as to mean what Websters dictionary states for this term; under the (2) definition of it....

1 : one of the months as named in the calendar. 2 : the period from a day of one month to the corresponding day of the next month if such exists or if not to the last day of the next month (as from January 3 to February 3 or from January 31 to February 29) :Webster dictionary

in CPT coding book it states...
under CPT 99457
“health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month”, .. (report 99457 once each 30 days,)”

It doesn't seem logical that it would be expected that every patient came in on the 1st of the month to receive their Remote device and begin being monitored.

I instructed this practice to use Pts start date as their calendar month..

Pt comes in and receives equipment on th 16th of the month.. every month thereafter would be this patients "calendar Month"
Please advise on any information you have on coding for RPMs.
It is greatly appreciated..

Shannon Douglass-Hughes, CPC, CPC-I
Coding Supervisor
Summit Healthcare
 
According to CPT guidance, RPM can be billed only once per episode of care (defined as “beginning when the remote monitoring physiologic service is initiated and ends with attainment of targeted treatment goals”) even if multiple devices are provided to the beneficiary.
99453 billed only once per trmt, 99454 billed every 30 days with minimum 16 days monitoring, 99091 each 30 days, 99457 & +99458 each month ( see guidelines)
Documentation guidelines must be met in detail
Codes are out of sequence in CPT If you have the AAPC/AMA version they are on page 52
Also good references to guidelines etc.
 
tvalaris said:
According to CPT guidance, RPM can be billed only once per episode of care (defined as “beginning when the remote monitoring physiologic service is initiated and ends with attainment of targeted treatment goals”) even if multiple devices are provided to the beneficiary.
99453 billed only once per trmt, 99454 billed every 30 days with minimum 16 days monitoring, 99091 each 30 days, 99457 & +99458 each month ( see guidelines)
Documentation guidelines must be met in detail
Codes are out of sequence in CPT If you have the AAPC/AMA version they are on page 52
Also good references to guidelines etc.
Click to expand...
Do you know about the wording "calendar month" in CPT book.. and what exactly AMA means by it.. under cpt 99457/99458 and all throughout for the "other" codes ?
 
CMS guidelines are specific to RPM CPT 99453,99454 (think "technical component" device supply and transmissions of16 day minimum required) DOS should correspond to the "first" upload of care, then each "30 days" should uploads continue and may be billed when 16 uploads are attained or each 30 days. It is expected in a 30 day cycle (not "calendar month") a minimum of 16 uploads were transmitted. 99457/99458 (think professional component "provider monitoring time" 20 min req) per calendar days. DOS may correspond when 20 minutes is completed or DOS for uploads as long as it is each 30 days. Note: During PHE for 99453/99454 suspected covid, symptoms, and or covid DX and recover, 16 day minimum is reduced to 2 days in those cases.
 
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