Update Notice: This content was updated to reflect the 2021 CPT code changes for Chronic Care Management. Specifically, the update includes the replacement of code G2058 with code 99439 and the nuances surrounding the change. The updates to this article are indicated in blue to make them easy to identify. Chronic Care Coding.
As your chronic care patients begin to feel it is once again safe to interact with the public, you should expect to see more of them at your office. This is important for their care, and also for your practice’s financial health. Chronic Care Coding.
Medicare provides you with a way to be more accurately compensated for the additional care and services you provide to your chronically ill patients. To access this added reimbursement, you must master the use of CPT care management and remote patient monitoring codes. Sounds easy enough, right? Wrong.
Some of your chronic care code options have specific bundling and diagnoses requirements that can make them tricky. Know these guidelines and you’ll open new REVENUE OPPORTUNITIES and finally get paid more of what you deserve for treating your sickest patients.
Care Management Planning, Supervising Chronic Care Coding
The only way to get paid for the additional time it takes and services you provide to your chronic care patients is to accurately bill for the supervision and planning of their care. Accurately recording and coding for ALL the time you spend performing care management services and adhering to the care plan requirements is the only way to capture this additional reimbursement (that you deserve). 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) services. 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: Last year, you likely used HCPCS code G2058 as an add-on code to 99490/99491 to capture each additional 20-minute increment of time spent on care management after the first 20 minutes. Now, G2058 has been replaced with 99439. The purpose is still the same—99439 is intended to fill the gap between codes 99490/99491 (first 20 minutes of time) and 99487 (first 60 minutes of time).
Single Chronic Condition Equals Principal Care Management Chronic Care Coding
To get reimbursed for treating patients with one high-risk disease or complex chronic condition (as opposed to CCM codes, which require at least two conditions) you must accurately utilize principal care management (PCM) codes. You can bill using the following HCPCS codes:
- G2064: Principal Care Management, at least 30 minutes of physician or other qualified healthcare 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 Provides Any-Location Monitoring Revenue Chronic Care Coding
CMS has been steadily 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, RPM 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. At this time, an in-person visit is not required to bill 99453, but it will be as soon as the COVID-19 public health emergency ends. Providers must have an established relationship with the patient to furnish RPM services.
- 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.
For 2021, CMS has clarified that the “interactive communication” required to bill 99457 can include both in-person and remote care. Previously, the interactive communication couldn’t count towards the 20 minutes of RPM care. So, interactive communication counts towards the 20 minutes, but providers can also include time spent reviewing remote monitoring data and updating the care management plan.
Medicare care management billing can be complex, but when done correctly, you can finally get paid for the additional time and effort you spent treating your sickest patients. To learn how to capture every care management dollar you deserve, attend the online training, Earn $50,946 More a Year for Treating Your Chronically Ill Patients, presented by billing and coding expert, Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO. In this 90-minute online training Kim will give you a step-by-step breakdown of how to compliantly take advantage of care management and remote patient monitoring codes so you can earn every dollar you are due. Sign up for this training today!
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