Answering Key Questions About A Remote Patient Monitoring Option

In a recent webinar, Jeffrey Lehrman, DPM and Matthew Garoufalis, DPM presented crucial information on “New Innovations in Remote Patient Monitoring to Prevent Foot Complications.” They shared why pressure assessment is critical to reduce plantar foot complications in at-risk patients, how trending physiological data might help guide patient care, and how a new insole system (Orpyx SI Flex Sensory Insole System) could have an impact. Additionally, they reviewed applicable CPT^® codes for remote patient monitoring services, which could provide a new income stream for providers in addition to potentially improving patient outcomes.

The webinar is on-demand and interested readers can access it here. In this blog, we will highlight key questions that attendees posed about this interesting innovation. 

Does the patient have to have diabetes or a history of wounds to qualify for the Orpyx SI Flex Sensory Insole System?

The Orpyx SI Flex Sensory Insoles are for any patient at risk of developing foot complications and would benefit from remote physiological monitoring from their provider. Specifically, Orpyx SI Custom Sensory Insoles are intended for patients with diabetes and are part of the diabetic shoe and insert program.

Can this system be united with a functional orthotic?

No, this device would be used instead of a traditional orthotic.

Can a provider dispense traditional diabetic shoes, the associated insoles, and the Orpyx SI system? If so, how would that work both logistically and from a coding perspective?

The provider can dispense traditional shoes as well as the Orpyx SI system. If the patient is qualifies for coverage of diabetic shoes, those can be dispensed using the HCPCS code A5500, and the Orpyx SI Custom Sensory Insoles can be dispensed using the HCPCS code A5514. Logistically the provider would prescribe and order both as normal, and bring the patient in to fit the insole in when both have arrived.

Isn't it too late to alter behavior if in "Do Not Disturb" mode, if alerts are turned off and data is uploading at the end of the day?

Probably not. Because the insoles store the data, these alerts will still be caught by the provider doing the monitor once the insoles are in range of the display and uploaded, giving us a better sense of what is going on with the patient as opposed to having them come in when a problem happens or on their routine visits. It will depend on the patient and their needs as well, some will benefit greater from that live feedback more than others.

Can patients buy the Orpyx SI Flex Sensory Insoles System themselves if are paying cash or do they need a prescription?

Patients are able to purchase the Orpyx SI Flex Sensory Insoles themselves via cash pay, but the remote patient monitoring must be prescribed and under the supervision of their provider when submitting for reimbursement to a third party payer.

In addition to pressure, doesn't elevated shear force strain on plantar structures cause tissue ischemia? If so, does this insole help identify those areas as well?

It does, which is one of the reasons it is important to point out that elevated pressure shear is a part of elevated pressure. In other words, if there is elevated pressure, there is likely elevated pressure shear.

What diagnosis codes are associated with coverage of these devices?

This is a really important point that applies to all services we as clinicians provide. There is no such thing as an official list that says “these diagnosis codes work for these CPT codes.” There are suggestions but no formal list that says CPT code X works with these ICD-10 codes, that just isn’t how it works. So with that in mind, just like any service we provide, use the diagnosis code that represents the diagnosis that has led you to provide this service.

How many Orpyx SI inserts can a patient get approved by CMS per year?

For Custom: As Orpyx SI Custom falls under the banner of the diabetic shoe and insert program, the HCPCS code A5514 applies, so just like any other insole that falls under that code, 3 pairs per calendar year.

For Flex: These are “off-the-shelf” and therefore do not fall under third-party payer coverage.  Therefore, there are no utilization limits imposed.

Does the pressure increase measured by Orpyx SI Flex Sensory Insoles correlate with increased weight-bearing under an anatomic area?

Yes, there is an increase in pressure in that area very likely related to weight-bearing, and that is a sign that it is a problem area and an area that we need to offload.

Do you need your own cell phone or is a cell phone device provided to the patient as part of system?

A digital display is provided by Orpyx for every patient using the Orpyx SI Sensory Insoles, therefore the patient does not need to use their own cellphone.

Dr. Garoufalis is certified by the American Board of Podiatric Surgery and the American Board of Podiatric Medicine with the Added Qualification in Amputation Prevention/Wound Care. He is also a certified Wound Specialist by the American Board of Wound Management. Dr. Garoufalis is in private practice in Chicago and also practiced at Jesse Brown VA Medical Center for 39 years and thus has extensive experience in treating the veteran population. He has authored many articles and has lectured extensively across the country, on a variety of topics pertinent to podiatric medicine and surgery and practice management.

Dr. Lehrman is a podiatrist in private practice in Fort Collins, CO and operates Lehrman Consulting, LLC. He is a Diplomate of the American Board of Foot and Ankle Surgery, a Fellow of the American Society of Podiatric Surgeons, and has been honored with the designation of Master by the American Professional Wound Care Association. Dr. Lehrman is also a Certified Professional Coder and Certified Professional Medical Auditor.

This blog is sponsored by Orpyx Medical Technologies.

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