Wiki Chronic Care Management

[wpienaar]

I work in a pediatric office and we employ several RN's who manage patients with chronic conditions. I would like to report this care with the chronic care management codes 99487, 99489 and 99490, 99439 and I have a few questions.

1. Is a summary of what the care manager provided during the month sufficient for documentation?
2. Do I need to show the care plan at the beginning of every month on the care summary?
3. The care manager is tracking her time, but some of her documentation doesn't appear to be specifically towards one of the chronic conditions, but due to the chronic condition of the child, she had to help guardian of the child through the decision making process. Is it appropriate to include that time or should the care manager tie it all together as it relates to the chronic conditions?
For example: If the patient has ADHD, is developmentally delayed and is in the process of closing a cleft palate/lip. The guardian of the child addresses new onset of congestion and a new onset of encopresis. The child sees a provider for the new onset of congestion and it is diagnosed a URI so the congestion may not be related to the chronic conditions of the child but the new onset encopresis does point toward some of the developmental delay. The pcp is consulted and recommendations are given to the care manager who communicates to the guardian of the child. Does the care manager need to tie that into her note to indicate it is part of the developmental delay of the child?
4. Do I use the diagnosis codes of the chronic conditions when reporting these codes?
5. Does anyone have an example of what a care plan and documentation should look like?
This is new territory for me and I want to make sure I get it correct before I report the services for payment.

 

[rthomas@impcna.com]

I work in a pediatric office and we employ several RN's who manage patients with chronic conditions. I would like to report this care with the chronic care management codes 99487, 99489 and 99490, 99439 and I have a few questions.

1. Is a summary of what the care manager provided during the month sufficient for documentation?
2. Do I need to show the care plan at the beginning of every month on the care summary?
3. The care manager is tracking her time, but some of her documentation doesn't appear to be specifically towards one of the chronic conditions, but due to the chronic condition of the child, she had to help guardian of the child through the decision making process. Is it appropriate to include that time or should the care manager tie it all together as it relates to the chronic conditions?
For example: If the patient has ADHD, is developmentally delayed and is in the process of closing a cleft palate/lip. The guardian of the child addresses new onset of congestion and a new onset of encopresis. The child sees a provider for the new onset of congestion and it is diagnosed a URI so the congestion may not be related to the chronic conditions of the child but the new onset encopresis does point toward some of the developmental delay. The pcp is consulted and recommendations are given to the care manager who communicates to the guardian of the child. Does the care manager need to tie that into her note to indicate it is part of the developmental delay of the child?
4. Do I use the diagnosis codes of the chronic conditions when reporting these codes?
5. Does anyone have an example of what a care plan and documentation should look like?
This is new territory for me and I want to make sure I get it correct before I report the services for payment.

You may want to check with your payers to make sure it's a covered service. Our local Blue Cross doesn't cover this service. I work for an Internal Medicine & Pediatric Clinic and we have never used CCM for our pediatric patients. Chronic Care Management is usually used for Medicare patients. I have attached what the requirements for Medicare are. Hopefully this will answer some of your questions.

 

[AC]

I work in a pediatric office and we employ several RN's who manage patients with chronic conditions. I would like to report this care with the chronic care management codes 99487, 99489 and 99490, 99439 and I have a few questions.

1. Is a summary of what the care manager provided during the month sufficient for documentation?
2. Do I need to show the care plan at the beginning of every month on the care summary?
3. The care manager is tracking her time, but some of her documentation doesn't appear to be specifically towards one of the chronic conditions, but due to the chronic condition of the child, she had to help guardian of the child through the decision making process. Is it appropriate to include that time or should the care manager tie it all together as it relates to the chronic conditions?
For example: If the patient has ADHD, is developmentally delayed and is in the process of closing a cleft palate/lip. The guardian of the child addresses new onset of congestion and a new onset of encopresis. The child sees a provider for the new onset of congestion and it is diagnosed a URI so the congestion may not be related to the chronic conditions of the child but the new onset encopresis does point toward some of the developmental delay. The pcp is consulted and recommendations are given to the care manager who communicates to the guardian of the child. Does the care manager need to tie that into her note to indicate it is part of the developmental delay of the child?
4. Do I use the diagnosis codes of the chronic conditions when reporting these codes?
5. Does anyone have an example of what a care plan and documentation should look like?
This is new territory for me and I want to make sure I get it correct before I report the services for payment.

Some general thoughts: The most important thing to focus on first is whether the patient has a chronic condition that places the patient at significant risk of death, exacerbation/decompensation, or functional decline. That criteria alone should weed out a lot of your patients who are somewhat stable and prevent you from billing CCM on them (if you are a true Peds clinic and don’t have a specialty in, say, oncology or some other specialty where there there is a high morbidity/decompensation rate). As far as documentation, I would expect that the RN would have several interactions per month with the patient/caregiver and would advise the RN to document a note on each DOS with time spent and specifics of what it was spent on.

 

[njycarter17]

I work in a pediatric office and we employ several RN's who manage patients with chronic conditions. I would like to report this care with the chronic care management codes 99487, 99489 and 99490, 99439 and I have a few questions.

1. Is a summary of what the care manager provided during the month sufficient for documentation?
2. Do I need to show the care plan at the beginning of every month on the care summary?
3. The care manager is tracking her time, but some of her documentation doesn't appear to be specifically towards one of the chronic conditions, but due to the chronic condition of the child, she had to help guardian of the child through the decision making process. Is it appropriate to include that time or should the care manager tie it all together as it relates to the chronic conditions?
For example: If the patient has ADHD, is developmentally delayed and is in the process of closing a cleft palate/lip. The guardian of the child addresses new onset of congestion and a new onset of encopresis. The child sees a provider for the new onset of congestion and it is diagnosed a URI so the congestion may not be related to the chronic conditions of the child but the new onset encopresis does point toward some of the developmental delay. The pcp is consulted and recommendations are given to the care manager who communicates to the guardian of the child. Does the care manager need to tie that into her note to indicate it is part of the developmental delay of the child?
4. Do I use the diagnosis codes of the chronic conditions when reporting these codes?
5. Does anyone have an example of what a care plan and documentation should look like?
This is new territory for me and I want to make sure I get it correct before I report the services for payment.

I work in primary care and we do bill CCM for patients. I don't know about pediatric patients since the patients we bill for are all adults, but for a patient to be eligible to bill CCM should have multiple (at least 2 or more) chronic conditions (ex. Alzheimer's, OA, RA, asthma, afib, autism, CA, cardio disease, COPD, depression, DM, HTN, infectious diseases...) expected to last at least 12 months or until patient's death and/or that place them at significant risk of death, acute exacerbation, and/or decompensation, or function decline and 20 minutes or more of care coordination services per month (minimum to bill must be at least 20 minutes).