Primary Care Coding Alert

Question: In order to bill chronic care management (CCM) services 99490 and 99439, how involved does the physician need to be?

North Carolina Subscriber

Answer: To bill CCM services 99490 (Chronic care management services… first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month) and 99439 (Chronic care management services… each additional 20 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)), the physician needs to be actively involved in the patient’s care and provide complete documentation to support their role in providing and overseeing the chronic care management (CCM) services.

Here’s how their involvement is necessary for billing these services:

1. Establish care plan: These codes require that a physician or other qualified health care professional (QHP) needs to establish, implement, revise, or monitor a comprehensive care plan for the patient during the month for which the code is reported. The physician or other QHP should assess the patient’s healthcare needs, set achievable goals, and identify the necessary interventions. The physician or QHP may also be involved in implementation and monitoring of the plan, although this more often falls to clinical staff under the physician’s supervision.

2. Direct clinical staff: The physician must oversee and provide direction for clinical staff who are involved in providing the care management services. Source: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf).

3. Time documentation: The billing physician should document his or her time spent on CCM services, including non-face-to-face care management activities, such as care coordination, medication management, and communication with patients and their caregivers.

4. Patient consent: The physician is responsible for obtaining and documenting the patient’s consent for receiving CCM services, either in writing or verbally, before initiating the care management services.