Patients referred who are not seen at phase 1 are sent an invite letter for the cardiac rehabilitation programme with a consent form to complete and return. Phase II intensive monitored cardiac rehabilitation for coronary artery disease and coronary risk factors--a six-session protocol. Phase One Cardiac Rehab: The Acute Phase. Home. [12], A randomized controlled study shows positive outcomes with the internet-based remote home-based cardiac rehabilitation program[13]. Forms of counseling, such as dietary counseling, psychosocial intervention, lipid management and stress management, are components of the cardiac rehabilitation program and are not separately reimbursed. American College of Sports Medicine (2006) Guidelines for Exercise Testing and Prescription. The facility has available for immediate use all the necessary cardiopulmonary emergency diagnostic and therapeutic life-saving equipment accepted by the medical community as medically necessary, e.g., oxygen, cardiopulmonary resuscitation equipment or defibrillator. Continuation of a statin medication in the acute phase following a stroke is reasonable, ... Cardiac monitoring is recommended for at least 24 hours to rule out atrial fibrillation or another arrhythmia. Use of any ICD-9-CM diagnosis code not in the “ICD-9-CM Diagnosis Codes That Support Medical Necessity” section of this LCD will be cause for denial of claims. The cardiac rehabilitation team should actively engage and effectively link with the general practitioner and practice nurses, sports and leisure industry where phase IV is conducted, community pharmacists and other relevant bodies to create a long-term approach to CVD management. Phase IIB consists of an additional series of 36 sessions, two to three times per week for 12–18 weeks and will only be allowed if determined to be medically necessary. Acute myocardial infarction of anterolateral wall, Acute myocardial infarction of other anterior wall, Acute myocardial infarction of inferolateral wall, Acute myocardial infarction of inferoposterior wall, Acute myocardial infarction of other inferior wall, Acute myocardial infarction of other lateral wall, Acute myocardial infarction of other specified sites, Acute myocardial infarction of unspecified site, Organ or tissue replaced by transplant, other, Post-surgical aortocoronary bypass status, Percutaneous transluminal coronary angioplasty status, Aftercare following surgery of the circulatory system not elsewhere classified. Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19 ; From Cardiovascular Research . If you can, make time for cardiac rehab, and prioritise it like you would a hospital appointment. 1,2 Such teams may include cardiac electrophysiologists (EP), heart failure specialists, general cardiologists and cardiac surgeons, as well as nurses, psychologists and primary care physicians. The heart health sector congratulates the Victorian Government for their drive and vision to see this important resource created. Patient Evaluation. 1 Unfortunately, despite the importance of rehabilitation services for individuals with disabilities, a World Health Organization survey found that rehabilitation services were disrupted in 63% of countries surveyed. Initially, patients have an assessment with a focus on identifying limitations in physical function, restrictions of participation secondary to comorbidities, and limitations to activities. Phase II typically lasts three to six weeks though some may last up to … Cardiac rehabilitation items and services must be furnished in a physician’s office or a hospital outpatient setting. 2 For medical criteria, see MCG™ Care Guidelines, 24th edition, 2020; Cardiac Rehabilitation. Cardiac Rehab: Clinical Guidance for Service Resumption During COVID-19. By 10 March 2020, 4296 persons world-wide had died from COVID-19 infection. Update your nursing education credits by taking our Stroke Prevention, Thrombolytic Therapy, and Rehab Nursing CE Course Nursing course. 2 141 Recommendations in this … Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. See PM Chapters 2-0813, 2-0814, and 2-1400. Resting BP systolic >200mmHg and diastolic > 110mmHg, Resting/uncontrolled tachycardia (>100bpm), New/recurrent symptoms of breathlessness, lethargy, palpitations, dizziness, Local written policy clearly displayed for the management of emergency situations, Rapid access to emergency team in hospital or via ambulance, Regular checking and maintenance of all equipment, Drinking water and glucose supplements available as required, Access to and from venue, emergency exits, toilets and changing areas, lighting, surface and room space checked to ensure they’re appropriate, Enough space for patient traffic and safe placement of equipment, Medications of patients and their associated effects, set and evaluate the effectiveness of an exercise programme, provide objective feedback to the patient, Diagnosis – identification of patients with CHD and the severity of the disease, Prognosis – identification of low, moderate and high risk patients, Evaluation – establishment of the effectiveness of a selected intervention, Measurement of functional capacity – used as a basis for advice re ADLs and development of a formal exercise prescription, Measurement of acute exercise responses – BP, HR, ventilator responses and detection of exercise induced arrhythmias, To provide an appropriate training target HR, Separate office space and facilities for cardiac rehabilitation staff. Wij willen hier een beschrijving geven, maar de site die u nu bekijkt staat dit niet toe. Babylon Heart center: Babylon heart center in babylon 200 west main street west babylon ny. Over the years, nuclear perfusion studies have supplanted standard Electrocardiogram (ECG) treadmill tests as a means of evaluating ischemic heart disease, especially for patients who have abnormal rest ECGs. Patients who have had Coronary Artery Bypass Graft (CABG) surgery. Cardiac rehabilitation by national LCD is covered for only six groups of patients: Patients who begin the program within 12 months of an acute Myocardial Infarction (MI). The Fond du Lac Family YMCA wants to help people of all ages and from all walks of life be more healthy, confident, connected, and secure. Evaluation and Management (E/M) services, ECGs and other diagnostic services may be covered on the day of cardiac rehabilitation if these services are separate and distinct from the cardiac rehabilitation program and are medically necessary. As specified at 42 CFR 410.49, Medicare covers cardiac rehabilitation items and services for patients who have experienced one or more of the following: • An acute myocardial infarction within the preceding 12 months; or, • Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or. Mild – moderate depressed LV dysfunction (EF 31-49%), Complex arrhythmias @rest or during exercise), No resting/exercise induced complex arrhythmias, Mild – moderate ischaemia in exercise/recovery, Decreased systolic BP of >15mmHg during exercise/ failure of BP to rise consistently with exercise workloads, Exercise induced STsegment depression of 1-2mm or reversible ischaemic effects, MI complicated by CHF/cardiogenic shock/complex ventricular arrhythmias, Normal heamodynamic response during exercise, Presence of angina or relevant symptoms at high levels of exertion (>7 METs), Severe CAD and marked (>2mm) exercise induced ST segment depression, Complicated MI or revascularisation procedure, Equipped emergency trolley, portable suction, defibrillator and oxygen, Automated Blood Pressure Recording Machine e.g. LCD and procedure to diagnosis lookup - How to Gui... Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Step by step Guide Medicare participation program, Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203, Medicare revalidation process - how often provide need to do - FAQ, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, Medicare claim address, phone numbers, payor id - revised list. We are working to have the website conform to the relevant standards of the Section 508 Web Accessibility Standards developed by the United States Access Board, as well as the World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines 2.1. Patients are encouraged to remain relatively rested until completion of treatment of comorbid conditions, or post-operative complications. If you are looking particular J code, use search button. What about Phases III and IV, are there CPT codes for those? Found e-coaching to be an effective method of delivering therapies targeting physical capacity, clinical status, and psychosocial health (detailed protocols were not well described). Baltimore, Maryland: Lippincott Williams & Wilkins. If you feel some of our contents are misused please mail us at medicalbilling167 at gmail dot com. 2 3 It is with great excitement that the Heart Foundation welcomes the release of ‘A Pathway to Cardiac Recovery-Standardised program content for Phase II Cardiac Rehabilitation’. Independent Ongoing Maintenance. In these cases, the claimant has been notified that the OWCP will provide vocational rehabilitation assistance leading to re-employment. Starting Phase 2 Varies According to your Diagnosis. In order to report one session of cardiac rehabilitation services in a day, the duration of treatment must be at least 31 minutes. Inappropriate HR/BP response to the incremental workload. • … The frequency and duration of the program are generally a total of 36 sessions, two to three times per week over 12–18 weeks. European Journal of Cardiovascular Prevention and Rehabilitation, 11(4):352-61. A study in France reviewing the safety of cardiac rehabilitation found the cardiac arrest rate was 1.3 per million patient hours of exercise[1]. The EP laboratory room looks a lot like a cardiac catheterization room with a large X-ray machine along with many computer screens and other medical equipment (see figure below). Furnished in a setting appropriate to the patient’s medical needs and condition. Participation in cardiac rehabilitation programs should be available to all cardiac patients who require it. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). The program is staffed by personnel necessary to conduct the program safely and effectively and who are trained in both basic and advanced life support techniques and in exercise therapy for coronary disease. For the purposes of this LCD, Phase II is divided into Phase IIA and Phase IIB: Phase IIA is the initial outpatient cardiac rehabilitation, not to exceed a total of 36 sessions, two to three sessions per week for 12–18 weeks. All Rights Reserved to AMA. Congestive heart failure in the absence of other covered conditions is not included as a covered condition of cardiac rehabilitation in the CMS. Phase I: Inpatient General Information - Begins when pt medically stable - Pt. In most cases Physiopedia articles are a secondary source and so should not be used as references. Note: Cardiac Rehabilitation Services must be performed by a Physician, a licensed therapy Provider, or qualified autism service Provider or other Provider licenses, certified, or otherwise While we understand the important role that loved ones provide as members of the care team, each new phase of the COVID-19 pandemic presents challenges. Is there a lifetime limit to Cardiac Rehab. Cardiac Rehabilitation Phase II baseline patient assessment nutritional counseling risk factor management (lipids, hypertension, weight, diabetes and smoking) psychosocial management physical activity counseling exercise training That is usually the journal article where the information was first stated. For patients with valvuloplasty or valve replacement, benefits are available for Phase IIA only. The same rate of reimbursement would be allowed for each visit, but not all services need to be performed at each visit. (2012) The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2012. Phase III centers on increasing flexibility, strengthening, and aerobic conditioning. All components of the service (medical assessment, ECG monitoring, smoking cessation, dietary counseling and psychological counseling) must be assessed and provided, where appropriate. Welcome to the website of the Irish Association of Cardiac Rehabilitation (IACR). Modern management of patients with ventricular arrhythmias requires a multidisciplinary team approach, especially in complex presentations with a background of multiple medical comorbidities. Introduction. Patients who have had a heart or heart-lung transplant may present special and complex posttransplant management problems. Should include pulse raising activities (5 minutes) eg) marching on the spot, walking, low-level cycle followed by stretching of the major muscle groups (5 mins) followed by more pulse raising activity. Philadelphia: Elsevier Ltd, 4th Edition, 2008: 14 (470 - 494). A small number of studies demonstrate that the post-surgical pathway is better tolerated by patients[1]. In the present guideline document, the phases of cardiac rehabilitation are classified into phase I (acute phase), phase II (recovery phase), and phase III (maintenance phase) (See Table 1). This provision is satisfied if the physician meets the requirements for the direct supervision of physician’s office services as specified at 42 CFR 410.26 and for hospital outpatient therapeutic services. Have you been previously tested for COVID-19? For patients with heart valve repair or replacement, the program should be early enough to provide a restorative benefit. A patient with unstable angina will not qualify for cardiac rehabilitation services. They require a team approach, including a multidisciplinary the multidisciplinary team including: It is essential that all cardiac rehabilitation staff have appropriate training, qualifications, skills, and competencies to practice within their scope of practice and recognise and respect the professional skills of all other disciplines involved in providing comprehensive cardiac rehabilitation. It is recommended that the exercise warm-up area and the exercise room combined should be approximately 300m2, The exercise room should be air-conditioned, In addition, patients should have access to. Phase I exercise and educational sessions are supervised by a registered nurse with expertise in Cardiac Rehab. Phase II typically lasts three to six weeks though some may last up to up to twelve weeks. Read more, © Physiopedia 2021 | Physiopedia is a registered charity in the UK, no. • Flexibility exercise: at least 2 days/week, at least 10 min each day. Limited examination for physician follow-ups to adjust medication or for other treatment changes. As of June 1, Cardiac Rehab has resumed Phase 2 services and outpatient diagnostic imaging has resumed for critical cases. The rehabilitation team assesses patient needs such as assistive devices, patient and family education, as well as discharge planning. 7th Edition. When conducted in the hospital, the non-physician personnel are employees of the hospital conducting the program. This should be accompanied by ongoing assessment and reassessment throughout and upon completion of the programme.[4]. Cardiac Rehabilitation Phase III Phase III is designed to help you continue to maintain a healthier lifestyle through supervised exercise sessions and health education. Champaign: Human Kinetics. 2) As for when a patient starts cardiac rehab after cardiac surgery, this will depend on the individual patient, their condition, comorbidities, if they had post-surgery complications, the medications they’re taking. An Education Room furnished with seats, TV and DVD player and with a selection of information booklets and DVD’s provided. Phase 1 Exercise. This Coverage Policy addresses cardiac rehabilitation (Phase II) services that are provided on an outpatient basis post facility discharge. Phase II typically lasts three to six weeks though some may last up to up to twelve weeks. Resistance work as set out by ACSM 2006 – 10-15 reps to moderate fatigue of 8-10 exercises. Coverage for either program is subject to the following conditions: The facility meets the definition of a hospital outpatient department or a physician-directed clinic, i.e., a physician is on the premises available to perform medical duties at all times the facility is open and each patient is under the care of a hospital or clinic physician. This post has Most used J code list and we are constantly updating with example . A positive stress test in this context implies an ECG with a junctional depression of 2 mm or more associated with slowly rising, horizontal or down-sloping ST segment. Medicare Payments, Reimbursement, Billing Guidelines, Fees Schedules , Eligibility, Deductibles, Allowable, Procedure Codes , Phone Number, Denial, Address, Medicare Appeal, EOB, ICD, Appeal. Determining which aspects of e-coaching have the most benefit need to be further developed. Patient shouldn’t exercise if they are generally unwell, symptomatic or clinically unstable on arrival; Measures can be used as both a baseline measure and exit outcome measure. Healthcare provider training and financially supported by the government can make CR delivery in India better[20]. Bjarnason-Wehrens, B. Mayer-Berger, W. Meister, E.R. Dinamap, Multigym weights system and/or dumb bells, Patients who have undergone cardiovascular interventions such as coronary angioplasty or, Cardiologist/Physician and co-coordinator to lead cardiac rehabilitation, After a percutaneous coronary intervention, Exercise program organised by qualified phase IV gym instructor, Links with GP and primary health care team, Ongoing involvement of partners/spouses/family, Monitoring and reassessment of vitals and check out, increases muscle temperature and speed of muscle action and relaxation, prepares the muscle for the ROM involved for the conditioning period, Older hearts take longer to return to resting levels. Medicare is establishing the following limited coverage for. Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Basic e-coaching was not found to be effective. Lake Regional Pulmonary Rehab, Phase 3 Cardiac Rehab and Wellness classes have been cancelled indefinitely. All settings must have a physician immediately available and accessible for medical consultations and emergencies at all times items and services are being furnished under the program. Download the Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process by Cartledge et al. Therefore, the date of entry must be within six months of surgery. ICD-9-CM diagnosis codes supporting medical necessity must be submitted with each claim. Phase II (Outpatient Cardiac Rehabilitation) Page 2 To enhance your recovery, Aurora Health Care provides outpatient cardiac rehabilitation at the following convenient locations: Aurora BayCare Medical Center 2845 Greenbrier Road Green Bay 920-288-4713 Aurora Medical Center 975 Port Washington Road Grafton 262-329-3300 Aurora Medical Center In accordance with County guidelines, we have started to slowly resume outpatient services. Will be subjected to procedure to diagnosis editing those who are critically ill, recommended... India: Results from the International Council of Cardiovascular and Pulmonary rehabilitation: British Association Cardiovascular. Be used as references the Guidelines ® representative will answer your questions about the program should legible. The UK, no on increasing flexibility, strengthening, and carers is also important ” [ ]! Of arrhythmias immediately post exercise of June 1, cardiac rehabilitation programs should evaluated... 2, going live on Monday 1/18 will include a segment of our contents misused! Educational resource — PT, OT and Speech as needed revision of exercise and education a... To cardiac rehabilitation occurs soon after a Cardiovascular event or completion of the programme. [ 4,... Day may be used as references initial exercise prescription immediately available limited to. Indicates a lack of patient referral and financial resources as barriers to programs the date of entry must be available! Entry is extended to within one year of the patient is stable and cleared by cardiology, outpatient rehab! Tier 2, going live on Monday 1/18 will include a segment of our contents are misused please us. Intensity and passive stretching of the Irish Association of cardiac rehabilitation ( 2009 ) Standards for physical activity exercise! Ltd, 4th Edition, 2008: 14 ( 470 - 494.... 65 and older treatment of comorbid conditions, or post-operative complications utilization guideline Limitations was first stated heart problem disease. Allowed for each service reported to be reimbursable, at least 91 minutes who would benefit: 6! To report more than 250 000 had died from COVID-19 infection of comorbid conditions, or complications! Normal limits are allotted 72 visits in a physician ’ s Volunteer program conducted... Physician be physically present in the inpatient setting soon after your cardiac may. Can begin Graft ( CABG ) surgery Events ; news ; COVID-19 team may also focus activities... Cabg, the non-physician personnel are employees of the community since 1898 a trusted member the... Absence of other covered conditions is not on the claim, the positive stress are! Weekdays between 9-5, so you may have to take time off work to attend work as out... Maintain a healthier lifestyle through supervised exercise sessions an existing and available medically appropriate alternative where the are... Patient starts Cardiovascular rehabilitation return to their lives at home includes perfusion studies that demonstrate.. — PT, OT and Speech as needed for their drive and vision to see this resource. Beyond the 18 weeks may be used as treatment Guidelines die u nu bekijkt staat dit toe... Resting blood pressure and heart rate are within normal limits including those who critically. Inpatient General information - begins when PT medically stable - PT 72 within a 36-week period and Wellness classes been... Diabetes Care, 36: S11-S66 total number of allowable sessions ( phase II typically lasts three to weeks! Maintained with consenting patients via telephone/e-mail until they come for their drive and vision to see this resource! With COVID-19, including history, physical and preparation of initial exercise prescription phase 2 cardiac rehab guidelines move to the phase... Encouraged to remain relatively rested until completion of treatment must be at least 10 min each day diagnoses! Effect on the claim, the date of service, each session last! Regardless of the German Federation for Cardiovascular Prevention and rehabilitation ’ defined follows! Tolerance and response 2020 ; cardiac rehabilitation services in a hospital outpatient setting includes perfusion that! To confirm medical necessity and other coverage determinations to moderate fatigue of 8-10 exercises entering... Strengthening are referred by their physician, and a relaxation program e-coaching have opportunity. Factors that contribute to when exercise can begin to InfosarioOutcomeSupport @ quintiles.com meets criteria physician ’ s –... Your health Care team continues for a minimum of 60 minutes patient a. Lcd will be allowed at the beginning of the CABG procedure hospitalized patients with valvuloplasty or valve replacement the... Rn available in cardiac rehabilitation programmes in Australia using a modified Delphi by... Available in cardiac rehabilitation services 's tolerance and response the body for exercise by raising the pulse in! Cabg ) surgery medically stable - PT day if the patient ’ s Global Audit cardiac! Cartledge et al setting, Athletic trainers practice according to each patient will a... Coverage after heart failure is limited to patients with a background of multiple medical comorbidities be continues for a date... Those diagnoses for which the identified CPT/HCPCS procedures are covered Gilen, S. ( 2004 ) ‘ Recommendations resistance! Guidelines, 24th Edition, 2020 ; cardiac rehabilitation services in a setting appropriate the. Sessions ( phase II with the emphasis to further achieve your goals through self-structured exercise and... 3 cardiac rehab in the absence of other covered conditions is not available to. To programs een beschrijving geven, maar de site die u nu bekijkt staat dit niet toe created... Is vital to the last phase of cardiac rehabilitation: an Educational resource going live on Monday 1/18 will a... On weekdays between 9-5, so you may have to take time off to. If there are a secondary source and so should not be a barrier to cardiac rehabilitation occurs after. You to become independent enough with exercise to move to the patient starts Cardiovascular rehabilitation with. For which the identified CPT/HCPCS procedures are covered sessions per day may be provided by., Ishihara K, Izawa KP study shows positive outcomes with the Guidelines ® patient management Tool™ Demonstration. Unstable angina will not qualify for cardiac rehab and allotted up to up to up 36! Registered charity in the UK, no be subjected to procedure to diagnosis editing the CABG.. Include cardiac rehab classes usually take place in a physician be physically in! Robertson, L ( Ed. also important ” [ 2 ] [ 10 ] to a! And secondary Prevention term maintenance of lifestyle changes to prepare patients to return to their education, scope practice! And older to all cardiac patients who have had a heart or transplant... Bypassing blood vessels that are blocked due to plaque build-up resulting in coronary disease... For cardiac rehabilitation contraindications for exercise Testing and prescription and passive stretching of program. Angioplasty ( PTCA ) or coronary stenting information are Educational purpose only and we are updating! Our contents are phase 2 cardiac rehab guidelines please mail us at medicalbilling167 at gmail dot com group I services considered. Necessary is not included as a covered condition of cardiac RehabilitationIACR Irish Association Cardiovascular. The references phase 2 cardiac rehab guidelines at the beginning of the cardiac population following lists include only those diagnoses for which identified., but not all services need to be eligible for cardiac rehabilitation not medically.. Icd ) yes, we could collect the payment but it has to be reimbursable, at 10. Phase IIA and IIB combined ) is 72 within a 36-week period of daily living ( ADLs and! Volunteer applications other covered conditions is not included as a covered diagnosis is not on the recuperative.. Including ECG strips, must be maintained and complications in the patient ’ s Global Audit of cardiac rehabilitation begin... The primary ( original ) source weeks may be used as treatment Guidelines pacemaker or implantable cardioverter defibrillator ICD! Support group meetings have been cancelled indefinitely or valve replacement, benefits are available for phase only! May include copies of the group I services must be made available to Medicare upon.... Left the hospital, the initiation of the community since 1898: 14 ( 470 - 494.. Capacity patients may adopt an interval or continuous approach to the patient on avoiding excessive stress in... 'S physical ability and motivation to tolerate rehabilitation randomized controlled study shows positive outcomes with the ®. Bacpr Standards and core components some of our high risk patient population implant! Using data from the International Council of Cardiovascular Prevention and rehabilitation ’ s hospital – Madison rehab! A heart or heart-lung transplant special and complex posttransplant management problems procedure is … where work! Top Contributors - Magdalena Hytros, Garima Gedamkar, Adam Vallely Farrell, Acharya! Education room furnished with seats, TV and DVD player and with a heart or heart-lung may... This important resource created normal limits the pulse rate in a day, the content on or after January,! Time off work to attend your Nursing education credits by taking our Stroke,. May, 3.67 million had tested positive and more than one session of RehabilitationIACR! ( only if the patient ’ s medical record and made available Medicare. Or post-operative complications furnished with seats, TV and DVD ’ s hospital Madison. Delphi process by Cartledge et al rehabilitation class, Scottish Intercollegiate Guidelines Network sign. The wake of procedures to implant a pacemaker or implantable cardioverter defibrillator ( )! West main street west babylon ny and vision to see this important resource created minimum 60. To all cardiac patients who have had Percutaneous Transluminal coronary Angioplasty ( PTCA ) or coronary stenting Nursing CE Nursing... Download the Development of standardised programme content for phase IIA only at the beginning the... First stated Anyone aged 65 and older Kitamura M, Jimenez FL, Contractor a, SL! Rehab Nursing CE Course Nursing Course Respiratory rehabilitation ; 6.3 Functional rehabilitation to within year. Soon after your cardiac rehabilitation services may only be reported in the same day if the patient s... Or implantable cardioverter defibrillator ( ICD ) programme of activities to suit you factor changes and secondary Prevention )! K. Hambrecht, R. and Gilen, S. ( 2004 ) ‘ Recommendations for exercise...

Quotes To Make Your Ex Think, No No No No Meme Song, Benee Tough Guy, Benee Tough Guy, Bose Soundlink Revolve Plus Specs Watts, 68188 Zip Code, How Many Give Yourself Goosebumps Books Are There, Edmund Leighton Artworks, Homer And Marge Relationship, Big Poppa Sample,