Coding Corner Issue 4
Orpyx recently announced the launch of the Orpyx SI® Flex Sensory Insole System. This wearable technology is an ultra-thin, prefabricated sensory insole that allows providers to monitor their patients’ plantar pressure, adherence, step count, and temperature. Dispensing this prefabricated option does not require any molding or scanning of the patient’s feet and does not require durable medical equipment licensure.
When providers monitor the physiologic parameters of pressure, activity, and temperature provided by the Orpyx SI Flex Sensory Insole, they may consider the following remote patient monitoring CPT® codes. For Medicare beneficiaries, as well as many others, these services can be performed under general supervision, which means trained staff may render the service(s) if furnished under the physician's overall direction and control. Furthermore, the supervising physician's presence is not required during the performance of the service(s).1
CPT 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. This code may be used when the device which is to perform the monitoring is dispensed to the patient and the provider performs set-up of all components of the device and provides education regarding proper use of the equipment.
CPT 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. This code may be submitted every month that 16 days of monitoring service with daily recording(s) or programmed alert(s) transmission is provided.
CPT 99457 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. CPT 99457may be submitted every month that qualified monitoring of physiologic parameters is performed with at least one live, interactive communication with the patient pertaining to this monitoring.
CPT 99458 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure). CPT 99458 is an add on code that can be submitted for each additional 20 minutes of monitoring.
As is the case for all claims submissions, there are documentation requirements that accompany the submission of each of these CPT codes that need to be met. For Medicare beneficiaries, some of these guidelines are outlined in the CY 2022 Medicare Physician Fee Schedule Final Rule: https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1751-f
Author: Dr. Jeffrey Lehrman, DPM, FASPS, MAPWCA, CPC is a Board Certified Podiatrist, Certified Professional Coder, Certified Professional Medical Auditor, and serves as Medical Director of Orpyx Medical Technologies, Inc. He is in private practice in Colorado and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance, and documentation.
Code of Federal (CFR) 410.32(b)(3)(i)
Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). CPT codes and their descriptions do not reflect or guarantee coverage or payment. The existence of a CPT code does not guarantee payment for the service it describes. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. Orpyx does not claim responsibility for any consequences or liability attributable to the use of any information, guidance, or advice contained in this document. Only providers are responsible for their coding and documentation choices.