Pain Management Coding Alert

Question: We have been struggling with coding for our patients who require chronic care management (CCM) and complex CCM; could you explain the differences between coding the two services, and offer some advice on how to track CCM time over the course of a month?

Illinois Subscriber

Answer: There are often questions on how to accurately report 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) and 99487 (Complex chronic care 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).

The basics: The guidelines preceding 99487 in CPT^® note that it is used to document the first 60 to 89 minutes of complex CCM in the month; anything beyond that is captured with +99489 (… each additional 30 minutes of clinical staff time …).

The descriptor for 99490 doesn’t include as exact a time component, as the descriptor only reads, “at least 20 minutes.” Because the code is open-ended, there is no add-on code for 99490.

Also, it is important to remember that cumulative CCM services of less than 20 minutes in a calendar month for 99490 and of less than 60 minutes in a calendar month for 99487 are not reported separately.

Tracking the time spent administering these services can be a real challenge. A good way to track time for CCM is to create a process to track it, or create a special build in your electronic medical record [EMR] to track and calculate minutes spent providing the service.