I. Identify and inform patients for the MedGem WatchWT™ Clinic
A. Medical screening process:
1. Patient visit: MA (medical assistant) obtains height/weight according to clinic protocol. At a minimum, this should be performed yearly, with each CPE at patient request, change in health status and every 6 months with those with chronic conditions. Monitor weight at each visit for patients with history of CHF, CKD or as determined by the physician.
The MA determines BMI (Body Mass Index) from chart or places measurements into EHR (Electronic Health Record) for calculation. Documents BMI in paper chart. The Medical Provider identifies candidates for diagnostic procedure (i.e. MedGem test).
2. Registry: MA or PA (Physician Assistant) conducts a query of patient outcome database for patients that have a BMI > 27 kg/m2 and a co-morbid disease state, (i.e., diabetes, hypertension, CVD). A list is compiled and the patient’s medical chart or EHR is identified.
B. Inform patient:
1. Patient visit
A. Medical Provider informs patient that bodyweight is a contributor to their medical issues and a recommendation is suggested to lose weight. Medical Provider assesses patient’s willingness to manage weight. The Medical Provider recommends the MedGem diagnostic procedure or CPT 94690 to help the patient begin the process of managing their obesity. The Medical Provider completes Patient Prescription for Weight Management form (see Section 2) and gives to the patient.
B. The Medical Provider notifies MA of MedGem diagnostic order through routing forms or computer in office messaging. Either the front desk or MA arranges scheduling.
C. MA/RN: provides details about the procedure and informs patient of appropriate pre-test requirements. RN/MA hands patient the “WatchWT™ MedGem” brochure (see Section 11) and answers questions about the test. MA/RN refers the patient to the front desk for scheduling.
2. Phone Call or Mailing
A. MA/RN provides list of patients to Medical Provider that are candidates for MedGem WatchWT Clinic. The Medical Provider approves the patients that need this MedGem WatchWT Clinic.
B. MA/RN: Patient is called or sent letter to inform them that the Medical Provider recommends the patient participate in MedGem WatchWT Clinic based on their BMI contributing to their disease.
C. MA/RN phone call explains the clinic, procedural requirements, answers questions, refers patient’s phone call to front desk for scheduling.
D. MA/RN letter explains the clinic and encourages patient to call front desk for scheduling.
3. Clinic Newsletter or e-mail
A. Inform patients of WatchWT clinic for patients to manage weight & health. Refer to Measure Metabolism handout (see Section 11) as a template for marketing to clinic patients or the following insert for clinic newsletters:
< Insert Your Clinic Name here> now offers a simple test to help you lose or maintain weight. This simple 10 minute test measures your metabolism and accurately calculates how many calories your body burns each day. You receive a 4-page report individualized to you that gives you the information you need to lose weight now. This test is often covered by insurance depending on your weight and medical condition. Talk to your medical provider or their medical assistant for further information.>
4. In-office marketing
A. Brochures, posters and flyers available in reception room and exam rooms.
II. WatchWT Scheduling/ Appointments
A. Front Desk
1. Front desk staff will schedule the patient for the MedGem diagnostic test during the time specified for this procedure. The office manager and nursing supervisor will determine the schedule.
2. If patient is calling to schedule a MedGem test, then front desk staff informs patient of pre-test requirements (see Section 3–Technician’s Measurement Script & MedGem Measurement Protocol Checklist).
3. MedGem appointments should be approximately 20-30 minutes (see Section 3–Optimizing MedGem Measurement Appointment Time).
4. A schedule is provided to the MA and updated regularly.
B. MedGem Appointment (approximately 20-30 minutes)
1. FRONT DESK: Receptionist provides patient with (see Section 6–MedGem Analyzer Patient Questionnaire) upon arrival.
2. PATIENT: Completes the MedGem Analyzer Patient Questionnaire in waiting room and returns questionnaire to the receptionist. Receptionist routes questionnaire to the MA per standard office procedure. The MA is notified by the computer check-in process.
3. MA or technician will conduct the measurement (see Section 3— MedGem Measurement Protocol Checklist).
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- Personnel will review the procedure with the patient and answer any questions (see Section 3— Technician’s Measurement Script).
- Patient performs test in designated area.
- Personnel records MedGem measurement on the MedGem Analyzer Patient Questionnaire.
- Personnel informs patient to return for results and counseling session. Return visit options are given to patient according to clinic availability or capacity.
a. Shared medical (i.e. Group) visit (SMV—45 minutes). If patient chooses SMV, explain Confidentiality & HIPAA Notice (see Section 7—A Guide to Conducting a Shared Medical (i.e. Group)Visit)
b. Individual visit with health coach, care manager, PA/NP, or physician (15 minutes — 99213 if patient does not have an appropriate comorbidity for billing).
c. Chronic care visit for DM, Healthy Heart (30 minutes –99214).
4. FRONT DESK: Receptionist schedules patient for follow-up accordingly.
5. MA enters MedGem Analyzer Patient Questionnaire data into MedGem Analyzer software program (see Section 6– Generating Patient Profile with MedGem Analyzer Software). MA prints the Your Personalized Weight Management Program report and gives to patient when they return for the SMV. MA prints the MedGem Analyzer Report (see Section 6 for reference) and files in the patient chart.
6. BILLING: Billing personnel use the appropriate diagnosis codes: PRIMARY (diabetes, hypertension, CAD, etc.) with SECONDARY diagnosis (overweight or obese). E/M code 99211 with MedGem ICD-9 code 94690. Billing will also track payment and payer information on all submitted claims or provided spreadsheet.
III. Shared Medical Visit (SMV) Follow-up
A. Visit time – 35-45 minutes
B. Front Desk
1. Personnel will call patients the day before to confirm group visit attendance.
2. Patient checks in at front desk or designated area.
C. MA, RN, NP, PA, HE, RD.
1. Allied staff counsels patients on nutrition counseling (See Section 7 – A Guide to Conducting Shared Medical (i.e., Group) Visit & Section 8–WatchWT Patient Education Materials)
A. Patient Visit/SMV:
a. Determines follow-up plans
i. Individual counseling
ii. Self-management
iii. Continues with SMV if provided service.
iv. Referral to RD
b. Optional: Ask patient to fill out Post-WatchWT Patient Questionnaire (See Section 13).
2. Provides patient with following handouts.
A. Your Personalized Weight Management Program report from the MedGem Analyzer software.
B. MedGem WatchWT Patient Education handouts in Section 8. Reviews major components of food label based on disease state (i.e. CHO—weight loss, energy balance, Type 2 diabetes; Total Fat & Cholesterol—CVD, CAD, metabolic disease; Sodium (Na)—hypertension, CHF, etc.).C. Promotes self-monitoring of nutrition and exercise.
D. Refers patient to self-management principles for primary disease.
E. Your Personalized Weight Management Program report is used for future reference follow-up visits.
3. Follow-up scheduled.
4. Document encounter in chart.
D. Billing & Insurance Reimbursement
1. Submit for reimbursement for SMV (group) visit.
IV. 99213-4 Individual Follow-up Visit
A. Visit times
1. Individual 15 minutes
2. Chronic care 30 minutes.
B. Front Desk
1. Patient checks with Front Desk.
2. Follow routine check-in process.
C. MA
1. MA escorts patient to exam room to visit with allied health staff.
D. RN, NP, PA, Physician
1. Allied staff counsels patient on nutrition counseling. Provides patient with following handouts.
A. Your Personalized Weight Management Program report from the MedGem Analyzer software.
B. MedGem WatchWT Patient Education handouts in Section 8. Reviews major components food labels based on disease state (i.e. CHO—weight loss, energy balance, Total Fat & Cholesterol—CVD, CAD, Sodium (Na)— hypertension, CHF, etc.).
C. Promote self-monitoring of nutrition and exercise. If appropriate, refer to other healthcare professionals specializing in weight management and/or other weight loss programs.
D. Refers patient to standard self-management principles for primary disease.
E. Your Personalized Weight Management Program report is used for future reference at follow-up visits.
2. Ask patient to fill out the Post-WatchWT Patient Questionnaire (see Section 13) and return to MA for data collection for outcomes.
E. Billing & Insurance Reimbursement
1. Submit for reimbursement for follow-up visit.
Click on the link for more information on the MedGem indirect calorimeters.
Call me directly at 720-431-1461 or send me an email to get your questions answered.
I wish you the best of health!
David Wilcoxson
Microlife Medical Home Solutions, Inc. All Rights Reserved. Microlife and WatchWT is a registered trademarks of Microlife Corp. MedGem is a registered trademark of Microlife Medical Home Solutions, Inc.