(277) Home Spirometry Billing: Don't Blow It!

Background:

Introduction: Spirometry testing and analysis is a key component in monitoring lung health of people with Cystic Fibrosis (PwCF). During the pandemic, the CF Foundation partnered with ZephyRx to distribute home spirometry (HS) devices. To date, 21,000 units have been distributed in the US. In June 2020, the Anton Yelchin Adult CF Center prioritized the delivery of units to its PwCF, provided education, and initiated the ZephyRx dashboard. ZephyRx offers online access to HS data $15/month per user, irrespective of number of tests performed in 30 days. Given the necessity of telemedicine paired with use of spirometry and the shift in reimbursable services, instituting a HS program for billable services was imperative.

Methods: Methods: In the fall of 2020, we attended a ZephyRx webinar for remote monitoring reimbursement. Information was presented to administration for support of a HS program including revenue potential. We collaborated with the revenue integrity team about CPT code reimbursement, insurance plan rules for billing, remote monitoring encounter generation, and build out of new CPT codes. We partnered with the auditing team to determine specifics for documentation supporting billable remote services. This led to a collaboration with the information technology team to build charge codes (facility technical and professional fee), electronic medical record location folder, a HS order, and a remote HS note template. Next, team members were identified to take on roles of the monthly process workflow. They updated a weekly HS log prompting encounter generation, verification of yearly test order, test upload, and end of the month billing for technical service. Providers were tasked to analyze and interpret HS results monthly. This included professional fee bill and documentation into a CF specific HS template with recommendations for continuation or changes in care plan.

Results:

Results: To date, 155 HS units were sent to our CF adults, 144 are set up and active on the dashboard. The following CPT codes were billed for remote services: 1) 99453 for initial set up including education and training by the CF Respiratory Therapist, 2) 94015 for technical service of HS test performed within 30 days, and 3) 94016 for professional analysis fee of patient-initiated spirometry within a 30-day period. PwCF under managed care plans were excluded due to required authorizations. In 2021, an average of 25 unique billable HS tests were performed by PwCF each month. The ZephyRx fee was waived for all centers the first six months and began billing thereafter. The cost for dashboard service was $4,230. In 2021, we were reimbursed $61,307.20 (CPT code 94015) and $4,548.72 (CPT code 94016). Therefore, net gain revenue for CPT 94015 and 94016 was $61,625.92.

Conclusions:

Conclusion: Our center’s HS program has demonstrated to be a viable billable service with revenue generation. However, due to limitation of fees waived for half of 2021 and the omission of billing managed care plans, the minimal projected revenue may have been $39,950 (assuming 144 users performed a test monthly). Identification of key stakeholders to create a formal process is paramount to a successful and profitable HS program. In the future, we propose inclusion of managed care plans for remote HS billing and the need for a designated staff to oversee our HS program at large.

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