Chronic Care Management Payments are Within Your Reach with Accurate Coding

With the spread of diseases and illnesses, chronic care management services are receiving increased focus. Chronic diseases are those that persist for more than a year and require continuous medical care. It comprises the very common diabetes as well as conditions that still require more focus light, such as depression. Therefore, chronic care management services include a variety of treatment ways ranging from in-person visits to coordinated care and interactive sessions.

As a result, there are particular coding guidelines framed for Chronic Care Management services (CCM). If you work without implementing the guidelines, your reimbursements will be a mirage to you, where it may appear that you are approaching payments but it seldom materializes.

Keep scrolling to learn more about the CPT codes for CCM.

Distinguish Your Patients

The toughest assignment for practices is meeting the revenue cycle management criteria, which has specific coding and documentation requirements.

There are two divisions in specific. The first is CCM, and the second involves complex chronic care management.

Listed below are the relevant CPT codes for both the care in chronic management, along with their descriptions, to entirely improve your reimbursements.

Current Procedural Terminology Codes Used For Complex Chronic Care Services

CPT Code 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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• Comprehensive care plan established, implemented, revised, or monitored,
• Moderate or high complexity medical decision making;

first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

To bill 99487 patients must be offered 60 minutes of consultation by clinical staff or qualified professionals to develop their care plan for each calendar month.

With this code, you can receive reimbursement for the first 60 minutes of non-face-to-face treatment.

Other criteria that come under this CPT code include the following treatment services and conditions:

• Those suffering from quite a few chronic conditions which persist for a year or more until their death and
• Conditions that cause people to become dysfunctional and increase their risk of death.

CPT Code 99489:  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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored,
• moderate or high complexity medical decision making;

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)

To bill 99489, the non-face-to-face sessions in complex chronic care should last at least 90 minutes. As a consequence, CPT 99489 is billed for every 30 minutes of additional consultation time.

CPT 99489 is an add-on code that is reported in conjunction with CPT 99487 to signify the extra time spent on treatment.

Code 99489 is meant to address the reality that caring for chronic patients takes time, thus providers can get the benefit of delivering the same..

Current Procedural Terminology Codes Used For Chronic Care Management Services:

CPT Code 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 that 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.

To bill 99490 patients must be offered 20 minutes of consultation by clinical staff or qualified professionals to develop their care plan for each calendar month.

CPT 99490 pays for monitoring and non-face-to-face CCM done by a qualified medical professional in the observation of a doctor. The main goal of this code is to pay for patients who have many prolonged illnesses. These long-lasting illnesses increase the patient’s likelihood of worsening health and may perhaps result in death.

Patient consent (verbal or signed) is needed, and the care plan must be combined with the EHR and should be made available to patients.

CPT Code 99439:  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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored;

each additional 20 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).

To bill 99439, the non-face-to-face sessions in chronic care should last at least 40 minutes. As a consequence, CPT 99439 is billed for every 20 minutes of additional consultation time.

CPT 99439 is an add-on code that is reported in conjunction with CPT 99490 to signify the extra time spent on treatment.

CPT 99439, combined with CPT 99490, is eligible to be applied on a monthly basis.

CPT Code 99491:  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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored;

first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.

To bill 99491 patients must be offered 30 minutes of consultation by clinical staff or qualified professionals to develop the care plan for each calendar month.

Patients suffering from multiple chronic illnesses that last a year or more before death.

Conditions that cause individuals to become dysfunctional and raise their risk of death.

Comprehensive treatment is being developed.

CPT code 99437:  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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• comprehensive care plan established, implemented, revised, or monitored;

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

The CPT 99437 is an add-on that is reported in conjunction with 99491 for service duration that is minimum of 60 minutes.

Difference between 99490 and 99491:  While the CPT 99490 requires clinical staff to perform the CCM services under physician supervision for billing, the CPT 99491 is used to compensate physicians or nurse practitioners for time spent personally in patient care.

Challenges In Your Way

Everyone wishes to offer effortless medical care, but managing each of your requirements on your own can be difficult. The most important issue is identifying the appropriate patients and corresponding needs for medical coding and billing.

You have to find someone with extensive experience managing CCM requirements and it is also essential to look after your internal team of workers. If you do everything by yourself, you won’t be able to breathe freely.

Final Thoughts

Even ants work together to find their food. They know the worth of teamwork and the value of their food. We value your needs; join us in making your job easier. Practolytics offers exceptional medical coding services that cover a wide variety of specialties and practice requirements. We examine the charts with expert coders and code the claims right there.

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