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The American Medical Association CPT (Current Procedural Terminology) Editorial Panel has approved the release of CPT^® code 0199T: Physiologic recording of tremor using accelerometer(s) and gyroscope(s), (including frequency and amplitude) including interpretation and report. Implementation date is July 1, 2009.

CleveMed has worked diligently with key personnel as well as members of the American Medical Association on the implementation of the 0199T Category III code to cover Kinesia^TM, a wireless patient worn device for objectively monitoring the severity of movement disorder motor symptoms.

Currently, Kinesia is the only device on the market that uses accelerometers AND gyroscopes, as defined in the description of the code, for the physiologic recording of tremor.

Kinesia is a compact device worn on the hand and wrist of the patient while they complete a video-guided upper extremity motor symptom evaluation. Symptom severity information is wirelessly telemetered to a nearby computer, increasing patient mobility and simplifying setup, where it is displayed and stored. Tasks for evaluating tremor, including rest, postural and kinetic, are automatically scored on a 0 to 4 scale. Severity scores can be viewed in customizable patient reports.

If you have questions regarding Category III codes, reimbursement or other information, please contact a CleveMed representative at 1-877-253-8363 or visit our website at www.CleveMed.com.

CleveMed is currently working with the Center for Neurological Restoration at the Cleveland Clinic to monitor motor symptoms during and after Deep Brain Stimulation surgery. To learn more about DBS, click here. Currently, motor symptoms are evaluated during multiple times during DBS surgery to determine if the optimal electrode placement has been determined. Kinesia ™ is being used to evaluate if better methods are available for measuring these symptoms to decrease the duration of the surgery, which can last for hours while the patient is fully conscious, and increase patient comfort. One potential application is to have the patient wear the device while their motor symptoms are being evaluated. The output of Kinesia could then be used as an objective measure from which to base the movement of the electrode.

In addition to the evaluations performed during the surgery, patients need to return to the clinic post surgery to optimize the stimulator settings once the surgical location is completely healed. Here, a nurse or clinician will evaluate the motor symptoms and adjust parameters of the stimulator such as frequency, amplitude and pulse width. As the settings are adjusted, the patient completes an upper extremity evaluation and this is sometimes completed multiple times, which can result in fatigue and therefore, not the most appropriate settings. Here, Kinesia can be worn by the patient while they complete these exams and the output of the device can be correlated to the most optimal stimulator settings. This can decrease the length of time of the visit, as well as increase patient comfort. If the device is able to suggest actual setting parameters, stimulator tuning can be completed in a typical clinician’s office instead of having the patient go to specialty movement disorder centers.

Parkinson’s disease (PD) is a neurodegenerative disorder that is caused by the death of dopamine producing neurons in the brain. Primary motor symptoms of PD include tremor, rigidity, bradykinesia (slowed movements or hesitations) and gait and balance issues. Since there is currently no cure for PD, the symptoms are treated typically with pharmaceutical interventions.

One of the more common medications prescribed for PD is L-Dopa, which is used to increase levels of dopamine in the brain. While effective, a common issue with the use of L-Dopa is that there is a fine line between the correct amount of medication and too much. Too much medication results in dyskinesias, or wild, uncontrollable movements. Also, the effectiveness of L-Dopa decreases over time.

When L-Dopa is no longer effective as a treatment for PD symptoms, patients can consider a surgical procedure called deep brain stimulation, or DBS. When patients opt to have DBS surgery, tiny electrodes are implanted in the brain through a hole in the skull which emit pulses of stimulation that aide in symptom alleviation. The location of the electrode can vary depending on the patient but the two most common are subthalamic nucleus (STN) and the globus pallidus interna (GPi). A patient can also have electrodes implanted on one side of the brain or both, depending on whether their symptoms are unilateral or bilateral. The electrode or electrodes connect to a pulse generator which is typically implanted below the skin near the collarbone. The implanted pulse generator, or IPG, controls the electrode stimulation output. Parameters such as amplitude (the power of the stimulation), frequency (how often the stimulations pulses occur) and duration (how long each pulse lasts) must be set.

During DBS surgery the patient is awake and fully aware. This is because a nurse must perform motor assessments with the patient to determine if the electrode has been placed in an optimum location and depth. This assessment includes motor tasks that the patient is asked to complete to determine the severity levels of their symptoms. This can sometimes be time consuming as the patient must complete the assessment each time the electrode is moved.

Once surgery is completed, patients will return to the clinic to have the IPG settings adjusted. Again, a nurse will administer a motor assessment and alter the amplitude, frequency and duration of the pulses until an optimum combination is found with best alleviates the patient’s symptoms. This adjustment is repeated a number of times as symptoms worsen due to the progression of the disease.

While the exact reason DBS works is still not known, the number of PD patient lives the surgery has improved is dramatic. Patients with debilitating motor symptoms that leave them nearly incapable of performing activities of daily living can have the ability to move and function as they did before their diagnosis of PD. This is not to say that DBS does not have risks. It is a major surgical operation and results are not the same for each patient. The first step to determining whether or not DBS would be appropriate for any PD patient would be to discuss their options with a certified movement disorder clinician or neurologist.

To demonstrate the benefits of Kinesia, a compact patient worn device for assessing Parkinson’s disease (PD) motor symptom severity, and the tremor scoring feature recently released, CleveMed has launched the new interactive website UPDRS.CleveMed.com.

Parkinson’s disease motor symptoms are typically assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), a subjective rating scale in which clinicians visually assess patient tremor symptoms and assign a 0 to 4 score based on severity. UPDRS.CleveMed.com highlights some of the reliability and consistency issues of the current method of PD patient evaluation.

The CleveMed UPDRS Scoring Challenge is an online educational tool intended for movement disorder clinicians and researchers, patients, caregivers or anyone interested in Parkinson’s disease motor symptom evaluations. The interactive site allows a visitor to view and rate a series of videos displaying Parkinson’s disease patients performing tasks for evaluating tremor. After each short video is complete, the user enters the score they feel is appropriate ranging from 0 to 4, 0 being the absence of symptoms and 4 being the most severe, and the next video starts. Once the twelve videos are scored, the user scores are compared to scores from two movement disorder specialists for the same videos. This demonstrates the variability in scores that can occur between different clinicians for the same patient, which is an issue with the subjective UPDRS. Scores are also compared to the automated scoring provided by Kinesia which demonstrates the benefits of having a device that can provide consistent, repeatable results.

Everyone is encouraged to try the site out and see how you would perform again actual clinicians when rating tremor symptom severity. If you find it interesting, please pass it along to others who may feel the same. Any comments, suggestions or questions on the site are welcome at any time.