EM Coding Alert

A new code allows reimbursement for CCM non-face-to-face time.

If you have been wondering when you should use chronic care management (CCM) codes, CPT® 2015 brings good news in the form of clearer requirements. If you don’t update your coding to match the new requirements, you’ll face denials after Jan. 1, 2015. 

To get a jump on the new year, continue reading to learn about the chronic care management code updates, as well as other E/M code changes that may affect your practice in 2015.

Embrace the Chronic Care Management Improvements

Changes to five CCM codes may make your chronic care management services coding less of a chore.

You’ll find that CPT® 2015 revises the descriptor for 99487 with bulleted detail as follows (emphasis added): (Complex chronic care coordination management services, with the following required elements:

• multiple [two or more] chronic conditions expected to last at least 12 months, or until the death of the patient;
  
• chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  
• establishment or substantial revision of a comprehensive care plan;
  
• moderate or high complexity medical decision making;
  
• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month) first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month)
  

“Adding the elements is definitely a positive; it gives the provider community a set of guidelines to follow to meet the documentation requirements of the codes,” says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. “Often we find that the providers are performing the services, but aren’t necessarily illustrating them as the payer would like to see in the documentation.”

In addition, you’ll see that CPT® 2015 deletes 99488 (Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month).

Don’t miss: For each additional 30 minutes of chronic care management your physician provides, you will still be able to report revised add-on code +99489 (Complex chronic care coordination management services; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month [List separately in addition to code for primary procedure]).

Bonus: You will also have two new CCM codes to choose from: 

1. 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, with the following required elements:

multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,

chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,

comprehensive care plan established, implemented, revised, or monitored

2. +99498 — ... each additional 30 minutes ....

Avoid Neonate Codes 99481 and 99482

Effective Jan. 1, 2015, there will be two fewer neonate E/M service codes when CPT® deletes the following codes:  

• 99481 — Total body systemic hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure)
• 99482 — Selective head hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure).

These codes were new in 2014 when they replaced Category III codes 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) and 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger). Experts are unclear why CPT® 2015 removes 99481 and 99482, or if there will be replacements for these two codes.

Keep in mind: Until the annual publication of the CPT® code set, small further revisions may occur to the 2015 codes. Keep an eye on E/M Coding Alert for additional news on the changes.