Remote Patient Monitoring . . . Codes to Help Capture These Medical Services

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS HIM Leave a Comment

Remote Patient Monitoring . . . Codes to Help Capture These Medical Services

Remote Patient Monitoring or RPM is expanding and expanding quickly. This type of technology can assist with the remote assessment and monitoring of chronic conditions such as, Chronic Obstructive Pulmonary Disease (COPD), Heart Failure, Diabetes, Obesity, Hypertension, etc. This monitoring process allows for clinicians to address changes and/or concerns in the patient’s conditions that the data indicates in a timely manner.

RPM services are defined as the “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable)”. More and more technology companies are developing the platforms and software for these remote medical devices. Although often used for “chronic” conditions, RPM, can be medically necessary for acute conditions as well, which was a CMS clarification made in January 2021.

The ICD-10-CM code will be vital in determining the medical necessity coverage. But keep in mind that one aspect of population health is the management of chronic diseases/conditions. Always check for denials related to medical necessity and the ICD-10-CM diagnosis code(s) and then discuss with your HIM coding professional.

Under the American Medical Association (AMA) Current Procedure Terminology (CPT) you will find several RPM codes to capture these services. This is a partial list of the RPM CPT codes:

99091 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitor) digitally stored and/r transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days

99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment

99454 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

99458  each additional 20 minutes (List separately in addition to code for primary procedure)

There are several parenthetical notes for each of codes, so always check the CPT codebook for specifics. Keep in mind that these codes are inherently non face-to-face.

In the 2021 PFS Final Rule, CMS made payment policies related to the RPM services described by CPT codes 99453, 99454, 99091, 99457, and 99458. Be sure to review the 2021 CMS Physician Fee Schedule Final Rule to obtain more information regarding RPM: https://www.cms/gov/newroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

In addition, CMS made some changes after the final rule, which were announced in January 2021. You can access this information at: 2021-00805.pdf (federalregister.gov)

Keeping on top of “digital health” can require ongoing education and even auditing of services. 

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