CCM Requirements: Boost Payup with Chronic Care Coding Mastery

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CCM Requirements: Boost Payup with Chronic Care Coding Mastery

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Chronic Care Coding original

A lot of your sickest patients have gotten even sicker due to self-isolation during coronavirus. As you encourage them to return for care, using CPT chronic care management and monitoring codes can help you get more accurately paid for the care you provide to this population.

What’s the catch? Some of your care code options have specific bundling and diagnoses requirements. Know these guidelines and you’ll open new REVENUE OPPORTUNITIES for your chronically ill patients without committing billing violations.

Care Management Covers Planning, Supervising Work

Be sure you’re coding for all the time you spend performing care management services and adhering to the care plan requirements. Here are some things to keep in mind:

  • Qualify patients: CMS requires that patients have two or more chronic conditions expected to last at least 12 months to be eligible for chronic care management (CCM) The conditions must also place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • Establish care plan: To bill for CCM, you must have a care plan that you update at least annually. While creating the basic care plan is part of the initiating visit (99490-99491), you can bill for extensive, additional work on care planning using add-on code G0506. The time you spend does not have to be face-to-face.
  • Get paid for plan revision and staff monthly time: For high-complexity patients, bill for the extended time to revise an existing care plan using complex CCM codes 99487 (Care coordination by clinical staff, first 60 minutes of non-face-to-face care) and 99489 as an add-on code to 99487 for each additional 30 minutes beyond 60 for each calendar month. Code 99487 requires 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
  • Capture extended time: Use HCPCS code G2058 as an add-on code to 99490/99491 to capture each 20-minute increment of time after the first 20 minutes. This code is intended to fill the gap between codes 99490/99491 (first 20 minutes of time) and 99487 (first 60 minutes of time).

If you want to read more, you can get everything you need to master the new CMS chronic care management 2020 requirements inside this brand-new Expert Report, Chronic Care Management Coding – Your Step-by-Step CCM Coding Guide to Help You Ethically Get Paid More for the Services You Provide to Your Sickest Patients created in collaboration with national coding expert, Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO.


­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Patients with Single Chronic Condition Qualify for Principal Care Management

Principal care management (PCM) codes provide reimbursement for managing a patient’s care for one high-risk disease or complex chronic condition (as opposed to CCM codes, which require at least two conditions). You’d bill using the following HCPCS codes:

  • G2064: Principal Care Management, at least 30 minutes of physician or other qualified health care professional (QHP) time per calendar month
  • G2065: Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other QHP, per calendar month.

PCM codes may be billed:

  • concurrently with Remote Patient Monitoring CPT codes (99453, 99454, 99457, and 99091)
  • “incident to” a billing provider under general supervision of clinical staff providing the services. Reminder: the supervising clinician’s physical presence is not required under general supervision.

Remote Patient Monitoring Provide Any-Location Monitoring Revenue

Over the past year, CMS has been working to encourage providers to adopt remote patient monitoring (RPM) technology by making it easier and more profitable to bill for. RPM uses technology tools to monitor and track patient data outside of a clinical setting, and in some cases, in-person visits are not required. Patients in care management programs (like CCM or PCM) are prime candidates (i.e. RPM for hypertension or diabetes). Plus, PRM isn’t subject to any patient location restrictions.

Use the following codes to get paid for remote patient monitoring:

  • 99091: RPM treatment management services for at least 30 minutes of clinical time per 30-day period. Must be provided by a physician or QHP—not clinical staff.
  • 99453 offers separate reimbursement for the initial setup of RPM equipment and patient education. An in-person visit is not required to bill 99453.
  • 99454: Use this code when providing the patient with an RPM device for each 30-day period.
  • 99457: Clinical staff time towards monitoring, and interactive patient communication via phone, text, or email. This code covers the first 20 minutes of clinician time per calendar month. Can be used for physicians, QHPs, and clinical staff.
  • 99458: This code is an add-on to 99457 and covers each additional 20 minutes per calendar month.

 Chronic Care Related Resources 

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Meet Your Writer

Jen Godreau
CPC, CPMA, CPEDC, COPC, AHIMA ICD-10-CM/PCS Approved Trainer

Content Director

Jen Godreau, CPC, CPMA, CPEDC, COPC, AHIMA ICD-10-CM/PCS Approved Trainer is an expert in practice management, billing and coding, and revenue cycle management, and brings almost 20 years of experience to the content team at Training Leader. Prior to joining Training Leader, Jen led implementations of EMRs and revenue cycle management services including credentialing. She has led teams who have created numerous software programs and tools for compliance, coding, and auditing. Her passion for all things compliance and coding has filled thousands of articles and allowed her to provide practice management consulting and due diligence for hundreds of practices.

Jen's advocacy led to the overturning of neonatology supervision restrictions, creation of new CPT ENT codes, and winning of Medicare monitoring auditing contracts. She wrote the diagnosis study guide for AAPC's Certified Otolaryngology Coder (CENTC) exam and edited the AAPC Professional Medical Coding Curriculum.

Jen has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She became a Certified Professional Coder (CPC) in 2001, added her designation as a Certified Pediatric Coder (CPEDC) in 2009, became a Certified Medical Coding Auditor (CPMA) in 2010, and a Certified Ophthalmology Professional Coder (COPC) in 2017. She is an AHIMA ICD-10-CM/PCS approved trainer.

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