Cardiology Coding Alert

Make the most of new bullet points for 99487 to meet documentation requirements.

To get a jump on E/M coding in the new year, review the following changes to chronic care management (CCM), including helpful new bullet points, and the changes to new time-based codes for advance care planning.

Embrace the Chronic Care Management Improvements

Changes to five codes may make your CCM services coding less of a chore.

You’ll find that CPT® 2015 revises the descriptor for 99487 with new bulleted detail as shown below:

• 2014: 99487, Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month
• 2015: 99487, Complex chronic care management services, with the following required elements:

             o  Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
             o  Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
             o  Establishment or substantial revision of a comprehensive care plan;
             o  Moderate or high complexity medical decision making;
             o  60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

 “Adding the elements is definitely a positive; it gives the provider community a set of guidelines to follow to meet the documentation requirements of the codes,” says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. “Often we find that the providers are performing the services, but aren’t necessarily illustrating them as the payer would like to see in the documentation.”

In addition, you’ll see that CPT® 2015 deletes 99488 (Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month).

Don’t miss: For each additional 30 minutes of chronic care management your physician provides, you will still be able to report revised add-on code +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]).

Bonus: You will also have another new CCM code to use when the CCM does not meet the requirements for the complex CCM codes:

• 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:

             o  Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
             o  Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
             o  Comprehensive care plan established, implemented, revised, or monitored.

Add Time Carefully for Advance Care Planning Coding

Two new advance care planning codes represent the work of a physician or other qualified professional, including discussions with the patient or his representative and completing any required forms. Code 99497 covers the first 30 minutes in direct contact with the patient or representative, and 99498 represents each additional 30 minutes after that.

The code descriptors are below:

• 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).

Clarification: Cardiology Coding Alert, vol. 17, no. 10, referred to +99498 as a chronic care management code based on a preproduction file of the CPT® codes. The latest information indicates +99498 is an advance care planning code, as shown above.