Wiki 99490 Charging For

[dabbler52]

For Code 99490.....when should that be billed?

This is the scenario

Patient age 70
No major health issues
History of hypertension
Went to doc upon doc's request for him to come in for a Annual Wellness Visit. He was told that the doctor was informed by Medicare that he had to do this.
Pt went in ...general exam. Renewal of script for hypertension med. Pt told to return in 6 months first, and then doc told him...oh for you...a year is fine. Just call for your refill.
That service was billed under 99487

Then every month since then pt has received a phone call from the office leaving a message on the machine this is Dr X office if any issues please return the call. Pt never returned call.

Pt receives EMOB showing a billing for 99490. Chronic Care Management Service min 20 minutes.

Is that allowed? As I read the description it seems that that code is not a monthly billable due to really just being a patient without a more complex healthcare need.


The provider is a single independent practiti

 

[thomas7331]

You are correct - chronic care management is not billable here based on the information you've included. For one thing, as you've stated, code descriptions for 99487 & 99490 both require two or more chronic conditions that "place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline", and 99487 also requires documentation of moderate to high MDM by the provider. 99490 would require 20 minutes of time per month, which would involve more time than just the amount required to leave a message on the patient's phone. In addition, and perhaps most important, under CMS rules, patient advance consent for participation is required for CCM - the doctor cannot just tell the patient that that are required to do this. From what you've described, this sounds like completely inappropriate billing.

Here's a link to Medicare publication on CCM that will give you more detailed information about the formal requirements for billing CCM services: https://www.cms.gov/Outreach-and-Ed...NProducts/Downloads/ChronicCareManagement.pdf