Home Health & Hospice Week

Pointer: Docs must pick one or the other between CCM and CPO.

Many of your referring physicians can earn more Medicare pay for your patients, but they need to know the ropes to claim their rightful reimbursement.

The Centers for Medicare & Medicaid Services delivered answers to several of the most frequently-asked questions about new-for-2015 code 99490 (Chronic care management…) during a May 13 CMS Physicians Open Door Forum.

“In response to inquiries we received about billing for chronic care management, we recently posted a list of FAQs on the CMS website,” said CMS’s Twi Jackson during the call. He explained a few of the highlights from the document in-depth during the call, and offered additional tips, which you can pass on to your docs to help them learn how to bill this new service properly.

The question: One of the most pressing questions for physicians serving home health and hospice patients is whether they can bill CCM and care plan oversight together.

The answer: Unfortunately, that answer is no. Docs can’t report CCM with home health care plan oversight code G0181, CPO code G0182, or ESRD codes 90951-90970, Jackson clarified in the forum. “Medicare does not allow CPT 99490 to be billed during the same service period as home health care supervision (HCPCS G0181), hospice care supervision (HCPCS G0182) or certain ESRD services (CPT 90951-90970) because care management is an integral part of all of these services,” CMS explains in the Q&A.

However, your physicians who don’t bill for CPO, either because they don’t meet the 30-minute criteria or don’t want the documentation hassle, may still be interested in billing for the less time-intensive CCM.

And CCM codes don’t conflict with docs who bill for certifying (G0180) or recertifying (G0179) a home health patients’ plan of care. Those codes don’t require time documentation.

Docs Can Initiate CCM During AWV

One of the biggest questions that Part B practices had about 99490 was whether the CCM service could be initiated during an annual wellness visit (AWV) or an initial preventive physical exam (IPPE). Fortunately, the answer is yes, Jackson said.

“The code addresses 20 minutes of chronic care management services per calendar month,” he noted. “It is for beneficiaries with two or more chronic conditions expected to last at least 12 months or until the death of the patient. CPT® 99490 is a physician-directed service and must be initiated by the billing practitioner during a comprehensive E/M visit, which also includes an annual wellness visit (AWV) or the initial preventive physical exam (IPPE),” he added.

In addition, most of your physicians’ clinical staff members can perform the CCM service. “A physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife, subject to state licensure and scope of practice, is eligible to bill 99490 directly or when qualifying clinical staff furnish the CCM services incident to the practitioners,” Jackson said. “A hospital may bill when the hospital clinical staff furnishes the CCM service at the direction of a qualified practitioner. Qualifying clinical staff is defined by the Fee Schedule’s incident to rules, as well as the CPT® definition of clinical staff.”

Face-to-Face Not Required

Unlike standard E/M codes, your referring physicians don’t necessarily have to see the patient face-to-face to report 99490, Jackson said. “While CCM is not typically furnished face-to-face, the time spent furnishing the elements of the CCM service face-to-face can be counted toward the 20 minute minimum,” Jackson said. “Also, time spent by the billing practitioner directly providing the CCM service does count toward the 20 minute minimum per calendar month service period.”

Inpatient, SNF exception: Let your docs know they shouldn’t be reporting 99490 for inpatients unless they meet one rare exception, Jackson said. “99490 cannot be billed for SNF inpatients or hospital inpatients because the facilities are already currently being paid for care planning and care coordination,” Jackson advised. However, “Time spent furnishing CCM services to patients while they are not inpatients during that calendar month can be counted toward the 20 minute minimum required to bill the code,” he added.

No TCM/CCM Combos: Your docs cannot report 99490 the same month as transitional care management (TCM, 99495-99496) “unless the 30 day transitional care management service period ends before the end of a given calendar month and at least 20 minutes of CCM services are subsequently provided during that same month,” Jackson said. v

Note: The CCM FAQs are at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1516.pdf. A CCM fact sheet is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf