General Surgery Coding Alert

Watch for deleted ‘face-to-face’ requirement.

With clearer guidelines for chronic care management (CCM) codes in 2015, you might just discover that you can occasionally use these codes in your general surgery practice when CPT® 2015 goes into effect on Jan. 1, 2015.

Read on to learn how you can use new and revised CCM codes, and get a jump on the new year. 

Embrace the Chronic Care Management Improvements

Changes to five CCM codes may make your chronic care management services coding less of a chore next year. You’ll find that CPT® 2015 revises the code descriptors to give bulleted details about what’s required to use the codes. 

For instance: Beginning Jan. 1, the definition for 99487 is as follows (underlined is new, strikethrough is deleted):

Complex chronic care coordination 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 
  

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.

“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 (Complex chronic care  management services; 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 a new CCM code for non-complex cases in 2015:

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
  

Know When Your Surgeons Can Use These Codes

General surgeons and their clinical staff often manage chronic conditions that could warrant using these codes. 

For instance: Make sure to consider the CCM codes if your surgeon and clinical staff manage conditions such as Crohn’s disease, ulcerative colitis, peripheral vascular disease, diabetic peripheral neuropathy and ulcer management, and any chronic comorbidities for these conditions.  

Caution: You need documentation that the surgeon manages at least two chronic conditions to consider using these codes.