# Chronic care management



## jberg@itctel.com  (Jan 27, 2015)

When using the chronic care management code,99490, can the patient who we are signing up, be a patient in a skilled nursing facility. I have read conflicting articles that says if the facility is a skilled nursing facility getting facility payments from Medicare than they are not eligible for this. Any help would be appreciate and also any links that can verify this would be a great help.


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## KMCFADYEN (Jan 27, 2015)

I am interested in the answer to that as well.  I have two pain management groups that want to bill this code and i am still researching it.


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## Pam Brooks (Jan 28, 2015)

The patient can be living at home, or at an assisted living facility.  A SNF is considered inpatient.  So you can't bill CCM for those patients.


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## jberg@itctel.com  (Jan 28, 2015)

The place of service code we use is 31. So would these patients be considered inpatient and therefore not qualify for the Chronic care management.


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## Pam Brooks (Jan 28, 2015)

joan.berg@sanfordhealth.org said:


> The place of service code we use is 31. So would these patients be considered inpatient and therefore not qualify for the Chronic care management.



If you look in CPT under the description for POS 31 it reads, "A facility that primarily provides _inpatient_ skilled nursing care......"


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## jberg@itctel.com  (Feb 10, 2015)

This is the response I got back from Noridian, which is our Medicare regional administrator.

Procedure Code 99490 (Chronic Care Management) is included in the Skilled Nursing Facility (SNF) Consolidated Billing exemption.  According to the following link, procedure code 99490 should be submitted to the Part B Medicare contractor: http://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/2015-Part-B-MAC-Update.html. To verify this information, please open the file called ?File 1-Part A Stay- Physician Services.? 

Now I am confused. Does this mean if they are Medicare Part B in the skilled nursing facility we can bill for the chronic care management but if they are Medicare Part A stay we can't.


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## dcraven (Mar 5, 2015)

*Chronic Care Management - how to track the service*

For the new CCM services how are you tracking the 20 min. activity for each patient during a 30 day period? I am looking for something that is not so time consuming!  Our practices have large Medicare population, this could get overwhelming!  I am looking for ideas or templates.


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## Pam Brooks (Mar 5, 2015)

We customized our EHR templates to do this, it was a lot of work, but we can generate the patient plan, automatically calculate time, provide a document to support billing and capture all of the elements of the CCM.


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## dcraven (Mar 5, 2015)

What EHR do you have?


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## trixiebh (Mar 10, 2015)

*Chronic Care Management*

I have read ICN 909188 on the Medicare Learning Network.  My question is does the patient have to have an office visit  (i.e. AWV, IPPE, or E/M) in order to initiate the CCM service prior to billing for the CCM?  Or can a clinical contact the patient directly to initiate the CCM service w/o an office visit?


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## teresabug (Mar 11, 2015)

pt must be seen in office for an E/M. Pt has to actually sign a form that the office can create stating they want CCM. When the patient no longer wants CCM care, they must sign off as well. This document HAS to be in the chart in the EHR. Their was a webinar I attended last week offered by Medicare. Check out cms.hhs.org and do a CCM word search. I know this will help you even more.


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## Pam Brooks (Apr 30, 2015)

To answer these questions:

dcraven, we use NextGen. 

And yes, CMS requires that the patient have received either an IPPE or AWV during the past calendar year.


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## kbartrom (May 4, 2015)

Pam - not to split hairs - CME requires AWV, IPPE _or_ comprehensive EM visit.  This question just came to my attention last week so this was fresh in my mind!


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## jberg@itctel.com  (May 6, 2015)

We have now been using the CCM code for a couple of months. Our clinic has hired two nurses to just call patients that are signed up for this. How are other clinics doing this?  Are you just billing for time, if the patient calls in with concerns? We have been having trouble with Medica MADV  plan denying these claims. Any one else having trouble with medicare advantage plans denying. Thanks for your input.


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