Guest Post: Documentation for chronic care management

CDI Blog - Volume 10, Issue 9

by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC

As CDI specialists and coders, it is our job to document and code appropriately for the care being provided. For CDI professionals working with physician practice settings, identifying documentation to support chronic care management codes under the Current Procedural Terminology (CPT) code system can be difficult. 

CPT code 99490, regular (“non-complex”) chronic care management assumes 15 minutes of work by the billing practitioner, according to a January 18, 2017 Frequently Asked Questions publication from CMS. The code incentivizes providers to manage and communicate more thoroughly between the multiple providers for patients with extensive and complicated chronic conditions. In addition to charting the time, the diagnoses for the two (or more) chronic conditions must be documented and clearly connected as medically necessary for this oversight care.

In the 18 months since code 99490 has been implemented, one of the biggest problems is physician reluctance to document and bill for it. Many providers have the basic criteria built into their electronic health records (EHR), yet do not use it. The EHR is the most effective way to meet the  criteria for billing of this code but a basic table in a hard copy chart or file can be just as effective and easy to use.

According to CMS, in fiscal year 2015, only 275,000 Medicare beneficiaries received (and CMS paid for) this service. Considering how many Medicare beneficiaries are enrolled and receiving Medicare services (approximately 54 million), 275,000 services provided with code 99490 is a very small percentage.

An area of continued concern from providers is they must also allow the patient to “opt in” and consent for this care. This can be problematic, as this is a non-face-to-face coordination of care and patients may view this as a charge for a service not rendered appropriately, as they did not physically “see” the provider. I’ve heard of patients complaining to their providers for having to pay for this “invisible” service. Again, it is imperative that the provider communicate clearly to the patient regarding this service and allow them to opt in or out. Physicians have also stated concern about whether they would be able to ensure or maintain 24/7 access to care management services as required by the CMS guidelines.

As a coder, billing code 99490 is one way to help your physician actually get paid for time spent performing this care management service. This service can include telephone calls, coordination of continuing services, and collaboration with specialty physicians which are services that are not normally paid for, or bundled in traditional E/M services. In addition to providing good patient care, the billing/coding of chronic care management code 99490 can also help the practice revenue stream and enhance the patients overall care.

Editor’s note: Webb is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist, with more than 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. Find current coding information on her blog: http://lori-lynnescodingcoachblog.blogspot.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article originally appeared on JustCoding.com.

Found in Categories: 
ACDIS Guidance, CDI Expansion