DBS Team and Documentation

1. DBS Team and Documentation Punit Agrawal, DO Movement Disorder Division Department of Neurology The Ohio State University

2. Team for Neuromodulation • Neurology/Pain/Anesthesia • Neurosurgery • Psychiatry/Psychology • Radiology • Physical Medicine and Rehabilitation • Beyond the physicians: • Physician assistants, Nurse practitioners, Allied Health • Ancillary staff including medical secretary/assistant, office manager, and clinical coordinator • Research • Ethics

3. Roles of the Team • Referrals and scheduling • Evaluation for therapy • Team review of evaluations • Pre-surgical evaluation • Surgery • Post surgical care • Therapy Management • Research

4. Documentation • Proper documentation and record keeping is important for several reasons including: • Allows for increased insurance approval for therapy • Records of neuromodulatory therapy results • Enhances communication with referring care provider and other team members • Assists in proper reimbursement of services • When concerns of complications of devices or failure of therapy, previous records are very helpful to identifying potential problems.

5. Medical Records • These should include • Pre-therapy screening tests including imaging, previous failed therapies, and evaluation reports from various team members • Goals of therapy • Surgical Reports and subsequent studies • Psychosocial evaluations and concerns • Post-operative notes and evaluations • Records of therapy intervention with results

6. Initial Evaluations - Key Items to Include • Severe debilitating disease with indication for therapy • Chronological history of disease • Previous failed therapies • Goals and expectations of therapy and discussion of potential risks/complications

7. Things to Document with Each Programming Visit • Disease Indication for Therapy • Therapy Target and Goals • Electrode/Device Models • Date of implant and battery changes • Device status (battery life, impedences, etc…) • Initial and Final Settings • Side effects or Complications • Patient/Family Education Provided

8. Sample of DBS Therapy Monopolar Review Worksheet

9. Sample Therapy Summary Sheet for DBS

10. Sample Letter for Prior Authorization

11. Sample Letter for Medical Necessity

12. Additional Key Elements to Successful Prior Authorization for Therapy and Reimbursement • Identify a staff member within the practice • to coordinate all prior authorization and • pre-certification processes with payers and • hospitals. • Involve the patient and/or family in the prior • authorization process as appropriate. • Follow the payer’s conditions for coverage. • Prepare a clear and concise letter of medical • necessity. • Educate the payer regarding the therapy, as • needed.