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Reference
Clinical Governance v3c — extract

Mandatory Escalation Triggers

From Companion SOP (Section 2). Every protocol must enforce these — they are not negotiable per provider.

  • MSK Pain score ≥ 8/10 → Tier 2 NP
  • PHQ-2 ≥ 3 (positive depression screen) → Tier 2 NP
  • Suicidal ideation → Emergency lock, 988/911, app locked
  • Patient requests clinical advice → scripted redirect to PCP/Urgent Care/ER
  • Any adverse event or safety concern → Tier 2/3
  • New or escalating acute pain → NP review before resume; in-person eval required
  • Cardiac red-flag zones (chest, left arm/shoulder, upper-left thoracic) + exertional or new onset → Emergency, 911

Escalation Tiers & SLAs

Section 6.4 — four-tier escalation hierarchy.

Tier 1 · Companion
24 hrs
Engagement drop-off, missed check-ins, mild pain increase. Scripted outreach.
Internal CoachFlow Companion (unlicensed, protocol-driven)
Tier 2 · NP
4 hrs
Sustained pain elevation, positive depression screen, patient request for clinical guidance.
Board-certified Nurse Practitioner (FNP / AGNP / PMHNP)
Tier 3 · Medical Director
2 hrs
Adverse events, scope-exceeding clinical questions, medication safety concerns.
Licensed physician (MD or DO), state-licensed in PC operating state
Emergency
Immediate
Suicidal ideation (988), chest/cardiac red-flag (911), stroke symptoms, immediate safety risk.
External — 911 / 988 with simultaneous internal escalation

CPT Codes — RTM Family

What CoachFlow bills. CMS labor type L037D permits MTA-class clinical staff for treatment-management codes.

CodeNameCMS RequirementBillable
98975RTM setup + educationInitial set-up and patient education on equipment useOnce per episode
98985Device supply, 2–15 daysPatient transmits data on 2–15 days in 30-day period (MSK)Per 30-day period
98977Device supply, 16–30 daysPatient transmits data on 16–30 days in 30-day period (MSK)Per 30-day period
98979Treatment mgmt, 10 min10 min clinical staff time, 1 real-time interaction, 2–15 day supplyMutually exclusive with 98980
98980Treatment mgmt, 20 min20 min clinical staff time, 1 real-time interaction, 16–30 day supplyMutually exclusive with 98979
98981Treatment mgmt, addtl 20 minEach additional 20 min beyond 98980Add-on code only

ICD-10 Standing-Order Categories

Section 5 — illustrative, not exhaustive. Each ordering provider configures their own list via standing orders.

Musculoskeletal & Pain
  • M15–M19Osteoarthritis (multiple joints / knee / hip / hand)
  • M54.xDorsalgia (back pain)
  • M79.7Fibromyalgia
  • M25.5xPain in joint
  • G89.4Chronic pain syndrome
  • M48.0xSpinal stenosis
Behavioral Health
  • F32.xMajor depressive disorder, single episode
  • F33.xMajor depressive disorder, recurrent
  • F41.xAnxiety disorders
  • F43.2xAdjustment disorders
  • F40.xPhobic anxiety disorders
  • F42.xObsessive-compulsive disorder
Cognitive & Neurological
  • G31.84Mild cognitive impairment
  • F03.xUnspecified dementia
  • R41.81Age-related cognitive decline
  • G47.xSleep disorders
  • R45.xSymptoms involving emotional state
Quality of Life & Recovery
  • Z73.xProblems related to life management
  • Z63.xOther problems related to primary support group
  • Z71.xPersons encountering health services for counseling
  • Z51.81Encounter for therapeutic monitoring

Eligibility Logic — Section 5

  • ELIGIBLE
    PEG-3 average ≥ 4 → eligible for RTM enrollment under standing orders.
  • ALT-SCREEN
    PEG-3 ≤ 3 with no qualifying pain → ineligible by pain pathway; route to GAD-7 / alternate validated screens for alternate dx (anxiety, mood, cognitive).
  • INELIGIBLE
    PHQ-2 = 0 AND no qualifying pain (PEG ≥ 4) → ineligible.
  • SUB-BRANCH
    PEG-3 ≥ 7 → branch to duration/severity. Pain >3 mo → chronic pathway; <3 mo → PCP follow-up before enrollment.

Source: CoachFlow_Clinical_Governance_v3c.pdf · Sections 1, 2, 5, 6. Diagnosis selection and medical necessity remain with the ordering clinician under standing orders.