CodingIntel

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

  • Become a member
  • E/M Changes for 2021
  • Learn More
    • What is CodingIntel?
    • Membership pricing
    • Free resources
      • Can I Get Paid
      • Nicoletti Notes
      • Everyday Coding Q&A
      • Newsletter Archives
      • NEW! Site map
  • Member Resources
    • NEW! Site map
    • Home
    • Articles
    • Coding Guides
    • Quick Reference Sheets
    • Webinars
  • Coding Education
    • Webinars
    • Courses
    • Specialty resources
    • HCC Coding Guide
  • My Account
    • Login
    • Logout
    • Manage Account

Chronic Care Management

•  Medicare covers chronic care management services if a patient has two or more serious conditions that are expected to last at least a year.

•  Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT® 99490, 99491, 99487, 99489 and 99439.

•  CPT® added a new CCM code in 2021, +99439.  It is new to CPT but replaced HCPCS code G2058 which is now deleted. 99439 may be used with code 99490 to report each additional 20 minutes of clinical staff time doing CCM. The definition of code 99490 was amended from “20 minutes” to “first 20 minutes.”

Use of CPT® codes 99490, 99439, 99487, 99489, 99491 and HCPCS code G0506

Chronic care management services are service provided to patients who have medical and/or psychosocial needs requiring establishing, implanting and monitoring a care plan. By definition, they are for patients who have two or more chronic illness expected to last for at least 12 months, or until the death of the patient, that place them at significant risk of death, acute exacerbation/decompensation or functional decline.

Some of the codes describe care provided by a physician or non-physician practitioner (NPP), and some describe services performed by clinical staff under the supervision and direction of a physician or NPP. If the service is provided by the physician/NPP, do not double count time spent in any other, billable activity.  All are for time during a calendar month.

They are divided into chronic care management and complex chronic care management. CPT® defines chronic care management for adults as those who are typically treated with three or more prescriptions and may be receiving other therapeutic interventions, such as PT or OT. For pediatric patients, there are three or more typical interventions, such as medications, nutritional support, or respiratory therapy. Typical patients have complex diseases and morbidities, and demonstrate the need for:

  • need for the coordination of a number of specialties and services;
  • inability to perform activities of daily living and/or cognitive impairment resulting in poor adherence to the treatment plan without substantial assistance from a caregiver;
  • psychiatric and other medical comorbidities (eg, dementia and chronic obstructive pulmonary disease or substance abuse and diabetes) that complicate their care; and/or
  • social support requirements or difficulty with access to care. [1]

Complex chronic care management has longer threshold times to bill, as well.

Additional requirements:

  • Verbal consent from the patient
  • Development of a comprehensive care plan
  • The patient must have a designated physician/NPP as their clinician, and have 24/7 access to address urgent needs
  • The practice must use a certified electronic health record, although faxing is allowed to share the care plan
  •  Use a standardized method to identify patients who are eligible for the service
  • Manage care transitions
  • Give a copy of the plan to the patient

99487 Complex chronic care management services, 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,
  • Establishment or substantial revision of a comprehensive care plan,
  • Moderate or high complexity medical decision making;
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

+ 99489 each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

99490 Chronic care management services 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;

First 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

Login to read the rest of this article


Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

click here!

 

Last revised March 4, 2021 - Betsy Nicoletti
Tags: care management

Looking for training on the new E/M Guidelines for 2021?

"Documentation Essentials for Codes 99202-99215 in 2021" is now available!

Take the two hour course on-demand, or sign up for one of our live events with Q&A.

Learn more

Latest Intel

Defining problems using the new 2021 office visit guidelines

The AMA has developed specific definitions for … Read More...

Essential documentation for medication management and psychotherapy

When providing both medication management and … Read More...

Insights: Changes in level of service using 2021 office visit guidelines

The American Medical Association (AMA) changed the … Read More...

2021 Office Visit Coding Insights | Webinar

2021 Office Visit Coding Insights March 25, 2021 … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health care management category of service CCM CMS Code sets and reimbursement Compliance compliance issues consults CPT®codes CPT® rules critical care Dermatology diagnosis coding Documentation Guidelines E/M other E/M services exam general surgery global surgery rules HCC HCPCS codes ICD-10 ICD-10-CM level of service MDM medical decision making Medicare Medicare rules modifiers new patient Physician Billing physician coding preventive medicine preventive medicine services primary care procedure coding prolonged services psychiatry risk adjusted coding screening teaching physician rules telehealth using time to select a code Wellness Visits
  • About
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

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.

Copyright 2021, CodingIntel
Privacy Policy