TX Methodist West Houston Hospital Cardiac free printable template

Cardiac Rehabilitation Program Referral Form Patient Name: Last First MI Home Phone: () DOB Day Phone: () Patient Primary Insurance: I am referring my patient to The Methodist West Houston Cardiac

How to fill out cardiac rehab referral form

How to fill out TX Methodist West Houston Hospital Cardiac Rehabilitation

1. Obtain the Cardiac Rehabilitation application form from the hospital's website or front desk.
2. Fill out your personal information, including your name, address, and contact details.
3. Provide your medical history, including any previous heart conditions, surgeries, or treatments.
4. Fill in your healthcare provider's information, including the physician who referred you to the program.
5. Indicate your current medications and any allergies you may have.
6. Complete the assessment questionnaire regarding your lifestyle, exercise habits, and dietary preferences.
7. Sign the form and date it to indicate that all information is accurate.
8. Submit the completed form either in person at the hospital or via email as instructed.

Who needs TX Methodist West Houston Hospital Cardiac Rehabilitation?

1. Individuals who have recently undergone heart surgery or procedures such as angioplasty.
2. Patients recovering from a heart attack or other serious cardiac conditions.
3. People diagnosed with heart disease who require assistance in managing their condition through exercise and education.
4. Individuals looking to improve their cardiovascular health and overall wellness.
5. Patients needing support in making lifestyle modifications to mitigate future heart-related issues.

People Also Ask about

What is the diagnosis code for cardiac rehab?

Article - Billing and Coding: Outpatient Cardiac Rehabilitation (A54070)

What is CPT code G0423?

HCPCS code G0423 for Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session as maintained by CMS falls under Cardiac and Pulmonary Rehabilitation Services .

What are 4 diagnosis that are eligible for Medicare reimbursement for Phase II cardiac rehabilitation?

A heart attack in the last 12 months. Coronary artery bypass surgery. Current stable angina (chest pain) A heart valve repair or replacement.

Can you bill G0422 and G0423 together?

Providers may bill HCPCS codes G0422 and G0423 for a maximum of six one-hour sessions of intensive cardiovascular rehabilitation per day and up to 72 one-hour sessions over an 18-week period. The combined total number of sessions billed with HCPCS codes G0422 and G0423 must not exceed 72 in an 18-week period.

What is CPT code G0422?

G0422 - Intensive Cardiac Rehabilitation; with or without continuous ECG monitoring, with exercise, per session. G0423 - Intensive Cardiac Rehabilitation; with or without continuous ECG monitoring, without exercise, per session.

What is the exercise routine for cardiac rehab?

“Generally, cardiac rehabilitation sessions involve a brief warm-up and stretching period, followed by 30-40 minutes of aerobic exercise. This can involve treadmill, stationary bicycle, elliptical or rowing machines. Sometimes, resistance training is incorporated. Finally, the session ends with a cool-down period.

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What is TX Methodist West Houston Hospital Cardiac Rehabilitation?

TX Methodist West Houston Hospital Cardiac Rehabilitation is a comprehensive program designed to support patients recovering from heart-related conditions. It typically includes supervised exercise, education on heart-healthy living, and counseling to reduce stress.

Who is required to file TX Methodist West Houston Hospital Cardiac Rehabilitation?

Patients who have experienced cardiac events such as heart attacks, heart surgery, or other cardiovascular issues are typically required to participate in the cardiac rehabilitation program.

How to fill out TX Methodist West Houston Hospital Cardiac Rehabilitation?

To fill out the TX Methodist West Houston Hospital Cardiac Rehabilitation forms, patients usually need to provide personal details, medical history, and information related to their cardiovascular health, which can be obtained during the intake appointment.

What is the purpose of TX Methodist West Houston Hospital Cardiac Rehabilitation?

The purpose of TX Methodist West Houston Hospital Cardiac Rehabilitation is to promote recovery, enhance physical fitness, educate patients about heart health, and reduce the likelihood of future cardiac events.

What information must be reported on TX Methodist West Houston Hospital Cardiac Rehabilitation?

The information that must be reported includes patient demographic details, medical history, current medications, assessment results, exercise tolerance, and progress in the rehabilitation program.