According to Centers of Disease Management and Control, half of adult Americans are suffering from chronic medical condition. Majority of patients are 65 or older and Medicare beneficiaries to whom family physicians are treating. Medical Billing Companies are helping these family physicians to submit claims. The American Academy of Family Physicians (AAFP) noted that effective use of chronic care management codes which will help physicians to increase their cash flow.
Chronic Care Management
Chronic care management is the non-face-to-face service provided to Medicare beneficiaries who have multiple chronic conditions, defined by ACP (The American College of Physicians). CCM helps physicians to provide higher patient satisfaction as this management is person centered and it helps to better health outcomes.
Some of important components of CCM:
- Communication with the patient and other treating health professionals for care coordination (both digital and by phone)
- Medication management and reconciliation
- Office visits and other face-to-face encounters
- Being accessible 24 hours a day to patients as well as other physicians or other clinical staff
- Creation and revision of electronic care plans by the designated CCM clinician
In chronic care there can be multiple physicians involved to provide treatment according to patient conditions. In this case practitioners need to coordinate to bill that patient as only one practitioner can bill for particular patient. It is important for family physicians to use the relevant CPT codes appropriately to ensure reimbursable chronic care management services.
Chronic care management CPT Codes
Prior to October 1, only three CPT codes were available to report CCM services. These three codes are 99490, 99487 and 99489. In 2019, CMS will implement another CCM code – 99491.
- 99490, non-complex CCM services, at least 20 minutes per month
- 99487 complex CCM, 60-minute timed service provided by clinical staff to substantially review or set up a comprehensive care plan with moderate- to high-complexity medical decision-making
- 99489 for each additional 30 minutes of staff time, only in conjunction with 99487
- 99491 Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month
CPT Code 99491
CPT code 99491 – Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored
This new code is meant to describe situations when the billing practitioner is doing the care coordination work that is attributed to clinical staff in CPT code 99490.
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