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Complex Care Management (Coordination)

Craig Posted Fri 30th of November, 2018 14:43:06 PM
Could you tell me the appropriate CPT code and billed amount for Complex Care Management services? We visit patients at the bedside in their hospital or in their home setting. We provide transition of care coaching and patient education dealing with high utilizers in the health system. Can you provide the code with billed amount for this service as well as any time limits for this code? thank you
SuperCoder Answered Mon 03rd of December, 2018 09:14:35 AM

Hi Craig,

Thanks for your questions.

Coding for chronic care management (CCM) and complex CCM includes three 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 ...

99487 - Complex chronic care management services ... 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

+99489 - ... each additional 30 minutes of clinical staff time ...

According to CPT® guidelines, that plan should include "but is not limited to, the following elements":

  • Problem list
  • Expected outcome and prognosis
  • Measurable treatment goals
  • Symptom management
  • Planned interventions
  • Medication management
  • Community/social services ordered
  • Direction/coordination of agencies and specialists unconnected to the practice
  • Identification of the individuals responsible for each intervention
  • Requirements for periodic review, and, when applicable, revision of the care plan.

Code 99495 and 99496 are used for transitional care management services and the provider performs management of a patient with an ongoing condition during the transition to home care after discharge from a healthcare facility.

Hope this helps.

Thanks.

 

 

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