Professional

Hi all, I'm just wondering if you guys can share your IE process. We have been trying to streamline our process as we still use a paper assessment form, LSI for telemetry and IE documentation, and also spots in EPIC for further documentation. A lot of this is duplicate information and I'm sure we could find a way to do away with the paper assessment. EPIC and LSI interface with each other but not as well as we would like. We only do 1:1 evals right now, we've tried group in the past though. We also try to exercise the patient during the eval if an MD is present (we do some IEs on phase 3 only days but there is an MD some days seeing patients) so we can bill right away. I'd welcome any input or sharing of your process. Also, are we in CR stuck with only 93798 and 93797 for billing? I'm pretty sure there are no other options like there are in PR, just thought I'd see if any of you have found ways to bill more frequently or to have faster turnover of patients.

Jason Butler MS, CEP

John Muir Health Cardiac Rehab

925-947-5254

Hey Jason, we use scottcare versacare system for telemetry and we use Epic for all of our IE documentation. We go through Pritikin ICR so we have G codes that we can use in addition to the 9 codes and with ICR insurance can reimburse up to 72 sessions compared to the usual 36. I also believe ICR reimbursement is higher per session compared to traditional CR.

We haven't tried group orientation but it might be a possibility if we run out of regular orientation spots consistently.

Our process is a sit down evaluation of the patient's condition, introduce them to the program, schedule their sessions, go through a chart and medication review, and we finish with a 6MWT. Generally, it takes us 90-100 minutes. We document in epic their goals and their scottcare-versacare reports gets automatically scanned into Epic. Hope this helps.

Jason,

I feel your pain on the multiple documentations! We are in the process of streamlining this too. Currently we have ScottCare for telemetry, EPIC for initial assessments, and paper printouts for ITPs (including initial ITP!). The paper ITPs are killing me as my previous CR clinic used LSI for all the ITPs including the IE. Unfortunately our ScottCare is not set up to do ITPs in that way. We are recently moving to do all the ITPs in EPIC, but we are not there yet and it will in the end involve more admin time (which is hard to get when you have classes all day!). But the goal is to get rid of the paper ITPs completely and have all the assessments in EPIC.

And....we still have paper charts. The information is manually typed into ScottCare. Why?!?!

Hi Jason.

Only RNs complete our cardiac Phase 2 evaluations, and RRTs handle the pulmonary Phase 2 evals. All of these are 1:1. We use a combination of paper and digital.

We use VersaCare for all documentation, and everything from the <60‑minute evaluation goes directly into VersaCare.

We print the physical assessment and place it in the front of the patient’s paper chart — a two‑pocket folder with fasteners. We still maintain a paper chart. We keep exercise tickets, resistance‑training worksheets, physician notes, med lists, op reports, H&P, etc. and sometimes even TheraBands all together in that folder. We have one desktop and two lap tops that run VersaCare. With sometimes 6 staff members on the exercise floor, having a paper chart is much handier than having to get to an available computer for the info.

Peggy Kraus, CEP, CDCES

Cardiopulmonary Rehab

Stony Brook Southampton Hospital

240 Meeting House Lane

Southampton, NY 11968

631-726-8620 office

Hi Jason,

We do a classroom style nonbillable orientation for our Cardiac patients and take up to 12 patients this way weekly. Once they attend the orientation, fill out papers ,etc we schedule them for their IE 1:1 billable the following week. We create the itp before they return for the first 1:1. This way we are adding at least 10 to 12 patients weekly. Our system is Scottcare and we only utilize the session reports and have it interfaced with our Epic. All other documentation is in Epic including our ITP. The codes you listed are the only codes that can be billed with cardiac rehab. If a session lasts more than 90 minutes for the IE you can bill twice and use a modifier 59 with two different codes. I'd recommended getting on the AACVPR dashboard. There are many resources for billing and coding and always questions like this being answered, which are applicable right to cardiac rehab. It's a great resource.

Yeah, I'm aware of the 59 modifier, we use that daily when we have education and exercise in the same day. I was just hoping someone else had a magic code I didn't know about, haha. I was really more interested in the IE process as we are trying to get away from paper to make it faster.

If you guys utilize Epic you could literally have them create the ITP through Epic to get away from paper documentation. I'm assuming that is what you are referring to when it comes to documentation. If you mean the questionnaires, you can have your Epic team create the questionnaires and send to patients to complete electronically. The only codes allowed for Cardiac Rehab are 93798 and 93798 exercise with telemetry monitoring and without monitoring. No specific code just for an IE but you can use both codes to bill for an IE. Just like your education you would use Modifier 59 for a 90 minute 1:1 IE. Cardiac rehab is a bundled service so you can't bill for anything else extra, such as 12 leads or glucometer, oxygen or testing. Just the 2 codes.

We have some of the questionnaires in EPIC but not all. LSI sends the IE (and other reassessments) to EPIC but it's missing a handful of things that we are currently charting on paper (and the paper also includes a ton of duplicate info). We'd like to get IT to get everything built into EPIC and I'm sure they could, but it seems like it will take forever and it's difficult to get that approved.