TMS R US

Row 1

100

What CPT Codes do we use and what do they stand for?

90867 - Cortical mapping

90868 - TMS visit

90869 - Redetermination

200

• What treatment number/s should you do a redetermination that has 36 or 60 treatments approved? 
• What insurance does NOT approve Rede's?

(36) Between 15 – 17 treatments with 1 redetermination

(38) 10th and 20th with 2 redeterminations

(60) 15th and 30th with 2 redetermination

Anthem does not approve Rede's anymore

300

• When and how do we incorporate a TB Anxiety into a patients treatment plan? Explain process

• We look at their GAD scores. 
• Check to see if anxiety is still high with patient and Dr. note.
• Do a TMS MD check in.
• MD TMS check in. PHONE CALL:  Jan Doe (LH)  123-456-7890. Would like to incorporates TB anxiety into her treatment plan - DA
• Phone call (15 minutes): non-billable, can do TMS that day.
• Telehealth: (30 minutes) Billable. No TMS that day.
• Remind patient of appt.

400

•  First auth. extension and second auth.  session
• Do you cancel appointment or what and why.

For the first extension, keep your patient on schedule while Miranda F. is working on an extension - DO NOT cancel any visits. Inform your team lead and MF on census and via chat

If your patient needs a second extension, this is when you would NOT see your patient and wait for Miranda F. (because it will go to peer review)

500

• What’s information do you need to input on Patient Census for a new patient?

Column A:  Patient name, Office, Red arrow/note with name of Insurance company and "A" for Anthem (no rede).

Column B:  Days and times of appointments (with earliest app first), NP's appt., Medicare ABN, Vacation, OCD pt (charge slip F42.9 or F33.2) etc...

Column C:  Daily copay amount; if payment plan 1/16 (update every week)

Column D:  Copay collection Daily or Weekly

Column E: Tx # and DOS

Column F:  Missed appointments 

Redetermination: Anthem = no re-d approved or if out of state plan (BCBS of TX) you will request re-d on census

Columns: G:  Redetermination  

Column H - L:  Weekly Attendance, Money collected, Provider appt = $, X, NP

Column M:  Total Copay/ End of the week collection

Column N:  Provider

Column O:  Dates of Approval

Column P:  Number of approved treatments

Column Q:  TMS Protocols

Column R: COLUMBIA-SUICIDE SEVERITY RATING SCALE  (CSSRS)

Column S: Notes

Row 2

100

Explain the BEAM measurement process (Magstim)

• Nasion to edge of cap ___cm
• Mark Inion ___ cm
• Nasion to Inion ___ cm 10% @ ___ cm
• Nasion to Midline (CZ) ___ cm
• Preauricular to Preauricular (Tragus to Tragus) over midline ___ cm 10% @   ___ cm
• Mark 4 areas upward around the head by 10%
• Head Circumference ___ cm
• (2) X Coordinates ___ cm
• Y Coordinate ___ cm
• Stimulator Output ___

200

Name TMS Contraindications 

Ferromagnetic metal in the brain

Electronic device (pacemaker)

TBI

Epilepsy/Seizure

Pregnancy (Right side Standard Anxiety)

Substance abuse (alcohol, drugs)

300

• What should you look at prior to seeing your cortical mapping patient?

• Doctors progress note and a provider if seen by one. 
• Aware of patient’s triggers
• History
• Medications
• Protocols recommended
• Patient forms if sent/signed
• PM site- Auth.#,  Dr., Dates of approval, CPT codes. Compare to Quick Memo
• Copay? 
• Confirm

400

What are the coordinates of the Depression Protocol?

POWER ( varies per pt ) 

FREQ (10.0) 

DUR (4.0) 

#PULSE (40) 

WAIT Time (10 seconds)

TRAINS (75) 

TOTAL PULSES (3000) 

MT% up to 120%

500

• TMS coils can stimulate the brain’s cortex non- invasively because:

The magnetic field passes through all body structures, such as skin, muscle and bone

Row 3

100

• What tabs do you have open on your bookmark?

• AMD EHR and PM
• Email
• Calendar
• Chat
• Vonage/Ring Central
• Patient Census

200

What the difference between On Label vs. Off Label? 

Name protocols for both labels

• On Label: FDA Cleared Indications: "Treatment of Major Depressive Disorder or OCD (MagVenture) in adults who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode" (Free TB Anxiety)

• Off Label: Theta Burst for MDD or Anxiety, Standard Anxiety, PTSD, Suicidal Ideations, Migraines, OCD (Magstim)

300

• What is the best practice to keep pts coming to tx as scheduled?              

Continually having meaningful conversations about how importance regular attendance is and the efficacy of treatment and FDA approved stats.

400

• What is the Safety Protocol on Chat we can use if we need help?

• HELP if it is NOT an emergency and you only need someone to come into your office and help you get a patient to conclude their appointment
• 
  
• 911 if it IS AN EMERGENCY and you need staff to dispatch the police right away
• 
  
• 911 and HELP if you need police assistance AND you need staff to come into your office right away

500

• Financial Hardship Applications Process

If you have a pt. that has an FHA and copies of pay-stubs has been checked, a paycheck stub must be uploaded into PM>Chart Files. If it has not been uploaded, you will inform your patient that they have 1 week to provide documentation. If they do not provide documentation, they could be responsible for the cash pay price as deemed by their insurance o Document in column B if this document must be obtained by the technician 

▪ ‘paycheck stub by 11/11/24’ - Inform your team lead (Jen) immediately if your pt. does not provide pay-stub documentation within 1 week

Row 4

100

ABN daily process?

Have patient sign daily with name and date.

CPT codes written in: (Make sure you have correct ABN form)

Note:  D._____      G:  Options D. ______

Place in folder and upload on Friday, except 30 day upload same day

Quick Memo:

DAILY ABN LAST FILLED OUT DATE 10/25/24 -DA

ABN 30 DAY QUESTIONAIRRE LAST FILLED OUT DATE 10/23/24 - DA

200

HOLD process:

Contact Denise/Jen/Angie immediately with chat with detailed information AND to add a note to Column E on census and a PD note

300

What is the process if your patient fills out question #9 on the PHQ9 or the BDI with a 2 or 3

Talk to your patient regarding question.                  Do they have an intent or plan?                              Are they feeling this way today? How long have they been feeling like this? How would they rate their intent or plan from 1-5. If patient states they don't have an intent or plan, just have a bad day etc... Document. Copy and past question with answer stating pating selected this however, has no intent or plan to harm themselves or others. Patient has felt like this for a year with with just thoughts for example. 

If yes to intent or plan do a CSSRS

Contact Denise/Jen if moderate/high

Document

Do we need to call Emergency contact             

400

• What’s information do you need to input on Patient Census for a new patient?

      Patient name

• Days and times of appointments
• Daily copay
• Tx # and DOS
• Missed appointments
• In insert type date, reason, if you called and outcome, your initials)
• Redetermination
• Treatment # week of
• Provider
• Dates of Approval
• Number of approved treatments
• Notes

500

Seizure First Aid. How to help someone having a seizure. 

Name the 3 "S's of seizures and what to do for each "S"

1. STAY with the person until they are awake and alert after a seizure. Time the seizure

2. keep the patient SAFE. Move things around them from harming them selves. 

3. Turn patient onto their SIDE if they are not awake and aware. loosen clothing around neck and a pillow or blanket under their head

Row 5

100

• Name the "4" ABN Forms.

90867, 90868, 90869. Have patient sign and date form. 

30 Day Questionnaire. Answer questions

200

• What to document when collecting copays:

•  The DOS, if payment plan, what number 2/12, how much you collected and your initials

300

Name Down Time Responsibilities you can do

• Ensure that your office is supplied with CaviWipes, gloves, disinfectant spray, masks, earplugs, hand sanitizer, tissue, paper towels, etc.
• Help the front office with scanning.
• Ask your co-workers if they need help with anything - be a team player!
• 10 consultation bags in your office at any given time.
• 
  

400

• What are the appropriate steps to follow in case of an emergency while patient is getting treatment?

• Stop the treatment  
• Pull the coil away from the patient
• Manage the patient’s condition and call for help (Denise/Jen)

500

• What 6 items do we confirm on the memo?

• auth #, provider, office, auth dates, CPT # of sessions and new: check all Anthem pts PA or insurance card to see if pts are carved out to a out of state policy or a 3rd party (look at PA and in upper left-hand corner of first page it will state only Anthem or BCBS of TX). If it is out of state, request the re-d immediately