3 Ways to Optimize Practice Revenue
- By Renee Dustman
- In Billing
- January 12, 2018
- 1 Comment
Your practitioners may be performing services for which they are neither being reimbursed nor receiving credit toward their quality reporting. You can help maximize their earning potential and receive credit where it’s due by pointing out these three separately payable services.
- Chronic Care Management
Chronic conditions (e.g., Alzheimer’s disease, arthritis, asthma, cancer, depression, HIV, stroke, and others) require additional work on the part of the practitioner. Medicare separately pays for non-face-to-face care coordination services furnished to patients who have two or more chronic conditions that are expected to last at least 12 months (or until the death of the patient).
CPT® codes are:
99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, 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
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 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.; 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)
Review CPT® guidelines and Medicare Physician Fee Schedule Chronic Care Management guidance for details on billing requirements.
The American College of Physicians offers a free “Chronic Care Management Tool Kit” your entire practice can use to formalize office policy.
- Transitional Care Management
Transitional care management (TCM) addresses the handoff period between the inpatient and community setting. After a hospitalization, family physicians often manage their patients’ transitional care. You can bill for TCM using:
99495 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge
99496 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge
Review CPT® guidelines and Medicare Physician Fee Schedule Transitional Care Management guidance for details on billing requirements.
Noridian Healthcare Solutions offers a comprehensive presentation on TCM designed to help the healthcare community understand TCM and how it works; comprehend a better insight on the changes to TCM made in 2017; learn how to reduce claim error rates.
- Advance Care Planning
When facing death, for whatever reason, it’s natural for a patient to want to discuss end-of-life planning with their healthcare provider. Even if a patient doesn’t want to talk about such things, it is the responsibility of the provider to offer the service.
Medicare pays for advance care planning (ACP) as either a separate Part B service when it is medically necessary or an optional element of a patient’s Annual Wellness Visit (AWV).
Report ACP with CPT® codes:
99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
99498 each additional 30 minutes (List separately in addition to code for primary procedure)
Review CPT® guidelines and Medicare Physician Fee Schedule Care Management for Advance Care Planning guidance for details on billing requirements.
Related reading:
Is End-of-life Planning an Optional Medicare IPPE Service?
Coding Chronic Care Management in 2017
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800-626-2633
What physician specialties can bill and be reimbursed for 99497 & 99498