99490 Chronic Care Management

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ebentley05

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Good afternoon, when billing the 99490 does the coordinating of care have to be for only the 2 life threatening chronic dx codes? For example: Pt has congenital pulmonary valve stenosis and anemia, which qualify for the CCM dx codes, however, the time spent for that month was for referral and plan of care due to milestone delays not the heart condition or anemia. Also, what is your understanding about obtaining consent in order to bill for this code?
 
It is my understanding that the time spent should be coordinating care for the chronic conditions. Also consent is required, I've posted some resources that better explain it.

The following is a great resource for these services - and includes a bit about the consent required.

Also several of the specialty organizations have resources for these services as well:

Private payers can have their own policies and don't always follow Medicare - just an FYI.
 
rachaelwilleford said:
It is my understanding that the time spent should be coordinating care for the chronic conditions. Also consent is required, I've posted some resources that better explain it.

The following is a great resource for these services - and includes a bit about the consent required.

Also several of the specialty organizations have resources for these services as well:

Private payers can have their own policies and don't always follow Medicare - just an FYI.
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Thank you!
 
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