Wiki Chronic Care Management

[hiebpa]

Can a cardiologist bill a CCM code or is this only meant for Primary Care Physicians? If a cardiologist CAN bill, how do we know we will get paid for CCM coding vs. the PCP? Whoever submits their charge first?

 

[Amy Pritchett]

I found this article for you. It seems to me that it is meant only for PCP offices but, you may find something different
http://www.physicianspractice.com/blog/new-payment-chronic-care-management-services

Hope this helps

 

[Pam Warren]

Remember that Chronic Care Management (99490) is to report the clincal staff work done (typically by RN care managers and other office-based staff) to assist patients with managing their multiple complicated chronic conditions. Essentially, those practices who have chronic care models in place are the ones who will most be able to show the ability to support the billing of this code.

One of the criteria for billing CCM is that patients must have 2+ chronic conditions that are expected to last at least 12 months or until patients' death. There are also EHR criteria, documentation criteria, and the need for an informed consent (check the Final Rule). Patients who have had home health certs/re-certs done by the supervising provider, who have had TCM charges billed and who are not at home/assisted living may not be eligible. Also, any practices who are currently being reimbursed by CMS for certain performance-based initiatives are also ineligible. (again, read the Final Rule).

Specialists will find this difficult to meet......although cardiology patients may have multiple chronic conditions, the cardiologist will likely be treating only the cardiac-related conditions. So Amy is correct in that this is a program more specifically able to be billed by Primary Care offices.

 

[BenCrocker]

Just playing devils advocate but could the patient have 2+ chronic cardiac conditions?