Meet The RM-3A Series Analytic System
The one-page Physician Dashboard provides a comprehensive overview of a patient’s health at-a-glance. The analytic system provides patient insights covering 8 key risk factors that are described in the pages that follow. Depending on the risk score for each factor, you will be able to determine the best course of action to resolve the patient’s condition as well as motivate your patient to immediate action.
The RM-3A Measures 8 Health Risk Factors
Autonomic Nervous System Dysfunction Risk
Problems with the ANS can range from mild to life threatening. Sometimes only one part of the nervous system is affected. In other cases, the entire ANS is affected. Some conditions are temporary and can be reversed, while others are chronic and will continue to worsen over time. Diseases such as Diabetes or Parkinson’s disease can cause irregularities with the ANS. Problems with ANS regulation often involve organ failure, or the failure of the nerves to transmit a necessary signal.
Sudomotor Dysfunction Risk
Sudomotor dysfunction testing may indicate to physicians of a patient’s peripheral nerve and cardiac sympathetic dysfunction. Neuropathy is a common complication in diabetes mellitus (DM), with 60%–70% of patients affected over lifetime. Symptoms of neuropathy are very common, and subclinical neuropathy is more common than clinical neuropathy. Neuropathy may remain undetected, and progress over time leading to serious complications. The most common associated clinical condition is peripheral neuropathy, affecting the feet. Autonomic nerve involvement is common but probably the most undiagnosed. Low scores in the sudomotor may lead a medical provider to look at clinical neuropathy.
Endothelial Dysfunction Risk
Current evidence suggests that endothelial function is an integrative marker of the net effects of damage from traditional and emerging risk factors on the arterial wall and its intrinsic capacity for repair. Endothelial dysfunction, detected as the presence of reduced vasodilating response to endothelial stimuli, has been observed to be associated with major cardiovascular risk factors, such as aging, hyperhomocysteinemia, post menopause state, smoking, diabetes, hypercholesterolemia, and hypertension.
Insulin Resistance Risk
Insulin resistance is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population. Insulin resistance occurs as part of a cluster of cardiovascular-metabolic abnormalities commonly referred to as “The Insulin Resistance Syndrome” or “The Metabolic Syndrome”. This cluster of abnormalities may lead to the development of type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome depending on the genetic background of the individual developing the insulin resistance.
The specific factors that can cause this increased risk include: obesity (particularly central), hyperglycemia, hypertension, insulin resistance and dyslipoproteinemia. When patients have one or more risk factors and are physically inactive or smoke, the cardiometabolic risk is increased even more. Medical conditions that often share the above characteristics, such as type 2 diabetes, can also increase cardiometabolic risk. The primary focus of cardiometabolic risk treatment is management of each high risk factor, including dyslipoproteinemia, hypertension, and diabetes. The management of these subjects is based principally on lifestyle measures, but various antihypertensive, lipid-lowering, insulin sensitizing, anti-obesity and antiplatelet drugs could be helpful in reducing cardiometabolic risk.
Small Fiber Neuropathy Risk
A small fiber neuropathy occurs when damage to the peripheral nerves predominantly or entirely affects the small myelinated fibers or Unmyelinated C fibers. The specific fiber types involved in this process include both small somatic and autonomic fibers. The sensory functions of these fibers include thermal perception and nociception. These fibers are involved in many autonomic and enteric functions.
Cardiac Autonomic Neuropathy Risk
High blood glucose levels over a period of years may cause a condition called autonomic neuropathy. This is damage to the nerves that control the regulation of involuntary function. When the nerve damage affects the heart, it is called cardiac autonomic neuropathy (CAN). CAN encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control, vascular dynamics and the body’s ability to adjust blood pressure. CAN is a significant cause of morbidity and mortality associated with a high risk of cardiac arrhythmias and sudden death.
Plethysmography Cardiovascular Disease Risk
The PTG CVD risk factor is the combined total of the other seven risk factors assessments. It takes into consideration the cardiovascular, as well as, the autonomic nervous system (ANS) measurements.
Allowable Medicare CPT Codes With Qualifications
Early detection allows the doctor to more effectively manage their patients’ treatment plans, thereby decreasing the risk of disease complications.
What are CPT and ICD-10 Codes? CPT Codes
Current Procedural Terminology Codes, or CPT Codes, describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
Testing of Autonomic Nervous System Function; Cardiovascular Innervation (Parasympathetic Function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, valsalva ration, and 30:15 ratio.
Includes measurement of beat-to-beat BP and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt. This testing involves continuos HR recording and requires photoplethysmograpgic best-to-beat BP recording. Analysis of HR and BP responses reflects the integrity of vasomotor andrenergic innervation.
Testing of Autonomic Nervous System (ANS) function; sudomotor, including 1 or more of the following: Quantitative Sudomotor Axon Reflex Test (QSART), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential.
Testing of ANS function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt (this code can be used to report both 95921 and 95922).
Simultaneous, independent, quantitative measures both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during test, paced (deep) breathing, valsalva maneuvers, and head-up postural change.
Non-invasive physiologic studies of upper or lower extremity arteries, single level, limited bilateral (e.g. ankle brachial indicies, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)