Wiki Remote Monitoring Billing

[brookelorraine11]

I have a question regarding remote monitoring CPTs and modifiers. If an RPM provider ships out a device to a patient, but the patient does not ever complete the test/monitoring, what, if any, methods are there for the provider to recoup their costs for prepping the device for shipment & shipping costs? I understand that initial RPM CPTs are intended to cover some of these costs, but they are also predicated on the patient completing (or least doing part of) the monitoring. Modifier 53 is for a discontinuation at the provider's discretion, and in this case, the patient is not following through and the monitoring not happening isn't the provider's decision, so I don't feel like I would have documentation to support 53. I was then thinking 52 for reduced services, but no monitoring has started. In addition the provider isn't electing to perform only part of the monitoring, it's the patient not following through. I've been researching this for over a week, and I cannot locate any guidance for this issue. Any insight would be much appreciated. TIA!!

 

[MonicaS17]

Unfortunately, we are having some of the same issues with some of our patients. With 99453, it states that it is the code is for the set up and instruction of how to use the equipment. You may be able to get that code at least for them receiving and learning to use the equipment. The monitoring does not allow usage of the modifiers mentioned, so you will not be able to do the monitoring.

 

[Yarbs]

Additionally, these are E&M codes reclassed as Care Mgmt codes really so reduced services does not apply. They are not procedures.