Presidents Letter
Dear MNACVPR members, 3/28/2012
SPRING!
At this time last year, I was wondering if we were going to have a Spring. This year I am on pins and needles wondering if Winter is still coming! You just never know what you’re going to get when you live in Minnesota.
I would like to introduce myself. My name is Teresa Fietek. I am your current MNACVPR president. I am married with two children, Courtney (15) and Tyler (12). We live in Lakeville, MN. I grew up in Babbitt, MN. I received my Bachelors degree in Clinical Exercise Science from the College of St. Scholastica in 1992, completed the CES in 1993, and became a Registered Clinical Exercise Physiologist in 2006. I work at Fairview Ridges Hospital in Burnsville, MN. This year marks my 20th year in cardiac rehab. There have been many changes throughout the past 20 years but there is one thing that has not changed…. And that is the impact that we have on our patients lives. Every day we have the opportunity to help make someone’s day a little brighter. Give them hope, encourage them through a rough time, or teach/support their new ways. We have the ability to influence change in our patients’ lives every day. They, in turn, do the same for us!
Kudos to you!
So, what is happening within your organization (MNACVPR)? Just like years past, we are feverishly working on providing two spectacular educational conferences. The Spring conference is right around the corner on April 10th 2012 at Methodist Hospital in Spring Lake Park. I hope you all can join us. We have quite the program planned. Please go to the newly built MNACVPR website for more details. Mark your calendars for the Fall Conference scheduled October 24-25th in Mankato!
The Disease management committee is near completion of the first of three planned flow sheet/algorithms. The algorithm was developed to assist programs with meeting the standards set for diabetes management. This next year they hope to develop the CHF algorithm. Please see more details within the MNACVPR newsletter. If you are interested in working on a committee please let one of the board members know or just come to one of the meetings. You can find the schedule on the website.
Newsletter: I am very excited about the newsletter. Dennis Angelotti and Aaron Pergolski have been working “non stop” I am excited to learn about various programs across the state. The newsletter will feature two programs, one larger and one small. Stay tuned as they are only waiting for my letter and then it is done!
Outcomes: John Inkster from St. Cloud is our outcomes chair. Please watch the website as more information becomes available on the National AACVPR Cardiac Rehab Registry.
Reimbursement: Reminder: the reimbursement committee, chaired by John Inkster (Cardiac) and Jessica Oman (Pulmonary), is set up to assist you with knowing the regulations and keeps you updated on changes to the laws for both cardiac and pulmonary rehab. This is another great reason for becoming a member of the MNACVPR!!
I will end with the Website. Please go to and check out what is new. Sign up for a conference, become a member, join the blog, and get involved.
I am pleased to be representing you as president of MNACVPR. Please feel free to contact me at 952-892-2528 or email .
Sincerely,
Teresa Fietek
Home Care and Cardiac and Pulmonary Rehab
Medicare Benefit Policy Manual – Chapter 7 – Home Health Services
Patients may attend CR or PR while enrolled in Home Care. CR and PR are considered to be medical appointments, and attendance at medical appointments does not disqualify an individual from the ability to receive home health services.
Pulmonary Rehab – Non-COPD patients
Billing G0237-G0239 codes
G0237-involves therapeutic procedures specifically targeted at improving the strength and endurance of respiratory muscles. Examples include pursed-lip breathing, diaphragmatic breathing and paced breathing. G0237 is reported/billed for each 15 minutes of one-to-one contact and face-to-face treatment. Documentation must support the duration and necessity of time billed.
G0238 involves a variety of activities including teaching patients strategies for performing tasks with less respiratory effort and the performance of graded activity programs to increase endurance and strength of upper and lower extremities. G0238 is reported/billed for each 15 minute of one-to-one contact and face-to-face treatment. Documentation must support the duration and necessity of time billed.
G0239 represent situations in which two or more patients are receiving services simultaneously (such as those described in above in G0237 and G0238) during the same time period. Practitioners must be in constant attendance but need not be providing one-on-one contact. G0239 is not a timed code and thus should be reported only once a day for each patient in the group.
Effective October 2010 these codes have been bundled based on “therapeutic procedures” and “monitoring” services. If a pulmonary function test is preformed on the same encounter with these codes G0237-G0239, CMS considers this to be “monitoring” and cannot be billed separately. NCCI edit has restricted the use of the 94010 (and other PFT category codes) with the pulmonary stress testing codes (94620 and 94621, 6MWT) and chest wall manipulation codes (94667 and 94668) and may see an audit. If a patient is seen for unrelated services and is performed separately (separated encounter) these may/can be billed separately.
Pulmonary Rehab – COPD
Billing codes G0424
G0424, defined as “pulmonary rehabilitation, including exercise (includes monitoring), per hour, per session”.The duration of treatment must be at least 31 minutes. No more than two sessions per day.
New G0424 code is bundled; additional services that are integral to PR patients, such as six-minute walk, initial PR program patient assessment, PFT’s, etc. cannot be separately billed.
These G codes (G0237-G0239 and G0424) are to be provided by a licensed healthcare professional (PT, OT, RN and RT’s) at this time Exercise Physiologists are not licensed in Minnesota and cannot bill under these codes.
More Changes Ahead for Local Medicare Contractors
A/B MAC Jurisdictions 5 and 6 (Minnesota, Wisconsin, Illinois, Kansas, Nebraska, Iowa, and Missouri)
Pulmonary Rehabilitation-National Correct Coding Initiative (NCCI) Edits.
CMS uses a program entitled National Correct Coding Initiative (NCCI) to promote correct coding methodologies and to control improper coding that leads to inappropriate payment of Medicare claims. NCCI edits are utilized by local Medicare contractors for physician services, hospital outpatient, and outpatient therapy services. Updates are published quarterly (January 1, April 1, July 1, and October 1).
The NCCI Policy Manual for Medicare Services, Version 16.3, was published October 1, 2010. It included the following edits affecting pulmonary rehabilitation and some related respiratory services.
Effective October 2010, certain procedure codes have been bundled into HCPCS G0237-G0239 and into G0424, based on existing code descriptors and the CMS 2010 Final Rule for Pulmonary Rehabilitation Programs. The code descriptors for G0237, G0238, and G0239 include necessary “therapeutic procedures” and all related “monitoring” services. Therefore, if pulmonary function tests (PFTs) are performed at the same patient encounter
as the services described by G0237-39 or G0424, CMS considers these tests to constitute “monitoring”. Consequently, PFTs are not separately reportable with G0237-39 or G0424. However, if the patient has an indication for PFT unrelated to the services described by HCPCS G0237-39 or G0424, the PFT may be reported separately if performed at a separate patient encounter. CPT/HCPCS codes under the PFT category include 94010, 94150, 94200, 94240, 94250, 94260, 94350, 94360, 94370, 94375, 94400, 94450, 94680, 94681, 94690, 94720, 94725, and 94750. Pulmonary stress testing codes 94620 and 94621 are also considered monitoring and included in G0237-39 and G0424 services. In the same way, CPT codes 94667 and 94668 (manipulation of chest wall…) are included in the code descriptors for HCPCS G0237-39 and are not separately billable.
What does this mean? Most pulmonary programs historically have billed for various components of respiratory therapy/care services (i.e., “component billing”). This NCCI edit has restricted the use of some of those components that were previously considered separate procedures from G0237, G0238, and G0239 by “bundling” what CMS now considers part of respiratory therapy/care services, just as pulmonary rehabilitation is a bundled code that includes exercise and all related monitoring services.
If a provider performs separate sessions of cardiac rehabilitation and pulmonary rehabilitation on the same date of service, both codes may be reported with an NCCI-associated modifier. (You would want to work closely with your billing department, since they frequently deal with NCCI modifiers.) CR and PR providers recognize that in the real clinical world, enrolling a patient in both programs simultaneously would be an extremely unusual circumstance.
Disease Management Committee
Dennis and Kari are currently working on a Diabetes Flow Sheet/Algorithm, for DM management. Algorithm for diabetes will be developed from standards set be other national guidelines to help cardiac and pulmonary rehabs programs direct their patients care. Further discussion followed regarding specifics of the flow sheet MNACVPR would support. There is concern about multiple tools, being utilized and how they interface with the Individual Treatment Plan (ITP). The algorithms are being developed to help programs guide their patients for standards of care which will be utilized with the current policies and procedures in each facility. We also talked about utilization of the PHQ-9 on admission to Phase II cardiac rehab. It was good to hear that many MN sites are giving the PHQ-9, for consistency. Other flow sheets/algorithms will be developed for other diagnosis for helping facilities create standards of care. Please refer to for completed algorithms in the near future.
There are many new and exciting things happening on the website. If you have not checked it out lately please do it is newly revamped.
We have apay pal account on the website so that you are able to pay with credit card.
You are able to log in to the Members only section and use the Form by using the user name as your member number and password a MNACVPR.
Please e-mail any facility phone and fax number updates.
St. Cloud Hospital
St. Cloud, MN
What programs do offer?
Our department name is Cardiovascular Health and Prevention Services, rather than the traditional Cardiac Rehab, though Cardiac Rehab is our bread and butter. We provide all Cardiac Rehab services including Inpatient, Early Outpatient, and Maintenance. We help with the exercise sessions and some education with the Pulmonary Rehab program. Our staff does the Nicotine Dependence Counseling for all inpatients, and we have an outpatient program as well. We provide a Workplace Wellness program for our health system employees for counseling on exercise and nicotine dependence. (There are also meetings for nutrition and stress management with other departments.) We provide Enhanced External CounterPulsation (EECP) treatments. We work with the Women @ Heart program – primary prevention for women. We also go to schools, businesses and health fairs to promote heart health and primary prevention.
What times do you have groups and how many patients to do you see in a group and per day?
Early Outpatient is available Mon-Fri. Mon and Wed we see pt’s at 7am, 8am, 9:30am, 11am, and 1:30pm. Tue and Thu we see pt’s at 8am, 9:30am, 11am, 1:30pm, and 2:30pm. Each group has 4 patients and one staff. We can see up to 20 pt’s per day.
Fridays is a discharge day with 7 separate discharge appointments. We still run the 8am, 9:30am, 11am, and 1:30pm groups as well.
Maintenance is available Mon-Fri 6am-4pm and closed from 12-1pm.
We have one staff person designated for the Early OP and one for the Maintenance pt’s. On Tue and Thu we have another designated staff seeing new patient orientations.
What are your patients to staff ratios?
Ph2: 4:1. Ph3: 15-1.
What are your therapists credentials?
All core staff in the department are Exercise Physiologists, either with their Bachelor’s or Master’s. Almost all of us have our ACSM Clinical Exercise Specialist certification. The Nicotine Dependence Counselors have their Tobacco Treatment Specialist certifications through the Mayo Clinic. Ancillary staff include Registered/Licensed Dietitians, Pharmacists, and Holistic Services providers.
Do you have education classes for your patients?
We have 8 education classes for the Ph2 patients; exercise, medications, risk factors, A&P/pathophysiology, stress management, and three on nutrition. We have RD’s teach the nutrition classes, a Pharmacist teach the meds class, and Holistic Services teach the Stress Management class.
What is your facility layout, equipment, square feet?
We have a gym (1781 sq ft) for all the exercise services, one exam/consult room, an education room, dietitian office, staff office, and locker rooms. We have primarily aerobic exercise equipment (about 25 pieces), but also have a universal weight training station and dumbbells. Aerobic equipment includes: NuStep, BioStep, Biodex UBE, treadmill, Airdyne, recumbent bike, upright bike, elliptical, arm ergometer, and rower.
Anything else you would like people to know about your program? New ideas different programs…
Our program has been continuously certified since 2001. We take pride in the outstanding work we provide and love working with new and challenging patients.
Saint Elizabeth's Medical Center
Wabasha, MN
What programs do offer?
We offer primary and secondary prevention programs. These include: Phase II CR and PR, Phase III maintenance, and Fresh Start Exercise and Education program (an 8-wk {self-pay} primary prevention program). In addition, we are also in charge of our Employee Wellness Program (includes annual biometric screening, individual consultations, exercise testing and prescription, and incentive programs). We also started a Worksite Wellness program last June which entails onsite wellness consulting, biometric screening, education, and exercise programming to area businesses.
What times do you have groups and how many patients to do you see in a group and per day?
We see 90-100 patients (a mixture of all primary and secondary prevention programs) on MWF from 7am-5pm and 40-50 patients on TR from 8-noon. We typically exercise an average of 12 patients an hour.
What are your patients to staff ratios?
Our patient to staff ratios are-
3:1for Phase II CR
3:1for Phase II PR
8:1 for Maintenance
3:1 for Fresh Start
Overall, we have 3 staff for 20 patients exercising at once.
What are your therapists credentials?
Our Director is a Masters prepared Clinical Exercise Physiologist and ACSM certified Clinical Exercise Specialist.
Our PR coordinator is an RN, BS, and ACSM certified RCEP.
The remaining staff are: a BS; and a Masters prepared Clinical Exercise Physiologist and ACSM certified RCEP.
Do you have education classes for your patients? Do you have dietician, pharmacist help teach those classes?
We have a 7-week rotating education class schedule featuring the following topics:
- Stress; Heart Anatomy and Pathophysiology; Risk Factor Identification and Modification; and Exercise (all taught by the wellness center staff).
- Food Labels; Heart Healthy Meal Planning; Carb Counting; and Pre-Dm/Intro to Metabolic Syndrome are taught by our dietician/CDE.
- Medication Therapy Management consultation is provided by our PharmD.
- Onsite Tobacco Independence and Diabetes Self-Management programs are also available.
What is your facility layout, equipment, square feet?
Our Wellness Center is 2,720 square feet and houses 20+ pieces of cardiovascular equipment:
-4 Treadmills-4 NuSteps -2 Octane Recumbent Ellipticals -4 ellipticals
-2 Arm bikes-2 Recumbent Bikes -2 Upright Bikes -2 Airdynes
It also entails free weights and eight weight machines to ensure a full body strength training program.
Anything else you would like people to know about your program? New ideas different programs…
Our CR program has been AACVPR certified since 2005 and our PR program since 2010. We also participated and enrolled 120 patients in a 3 year metabolic syndrome pilot study. We are in the beginning stages of implementing a PAD (specific) program.
The award is given annually to an individual for outstanding contributions and leadership in the MNACVPR and the practice of cardiopulmonary rehabilitation.
Criteria:
Nominee(s) will be a current MNACVPR member or, if retired, was a current MNACVPR member at the time of retirement.
Nominee(s) will have earned prominence within the state in the field of cardiopulmonary rehabilitation.
Please complete the nomination form below, and write a compelling paragraph in support of your nominee.
Suggestions include:
how this individual influenced the practice of cardiac/pulmonary rehab
what was the most important thing you learned from this individual
what you would like us to know about this individual
Nominations will be accepted until 08/24/12.
Send nomination letters to:Teresa Fietek
e-mail:
Nominations will be voted on by the Board of Directors and announced at the state meeting in October.