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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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March 29, 2023

Coding Guide – Care Management Services

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CMS has a stated goal of recognizing management services provided outside of an office visit. In particular, valuing and paying for care management and other non-face-to-face services. Sometimes, this means recognizing existing CPT® codes, and changing the status indicator from bundled to active, so that it is a covered service. Sometimes, it means working with CPT®’s chronic care management committee to develop new codes that describe management services.

Although CMS is thinking about primary care, many of these codes can be billed by any specialty physician. Transitional care management may be billed by one physician/NP/PA who is providing the TCM services. (The surgeon may not bill during the global period.) Chronic care management may be billed by any specialty physician who is providing the service. The new collaboration of care for patients with behavioral health diagnoses is meant for primary care practices. (PCCM).

This guide also discusses the rules for home health certification. The payment isn’t high, but it is a service that is commonly performed.

Other non-face-to-face services, including on-line digital evaluation and HCPCS codes G2012, G2010 and G2252 are discussed in articles on CodingIntel.

Table of Contents

  • Home health certification – G0180, G0179
  • Transitional care management – 99495, 99496
  • Chronic care management – 99487, 99489, 99490
  • CCM by physician/NPP – 99491
  • CPT bundling
  • Date of service and clinical staff
  • Principal Care Managment Services (PCM) – 99424—99427
  • Psychiatric Collaborative Care Management Services (PCCM) – 99492—99494
  • General Behavioral Health Integration Care Management – 99484

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Last revised March 10, 2023 - Betsy Nicoletti
Tags: care management, primary care_essential resource

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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