Urology Coding Alert

Pay attention to ‘face-to-face’ changes.

While urologists don’t often perform chronic care management services (CCM) for patients, if any CCM claims cross your desk, you’ll want to pay attention to changes coming on Jan. 1, 2015. 

Read on to learn how the new and revised CCM codes with clearer guidelines might change how you report some services. 

Embrace the Chronic Care Management Improvements

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

You will 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 in 2015:

• 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

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

Note: Urologists will rarely experience a clinical scenario for which they will use these chronic management codes; however, a urologist may code for chronic management of his patient with carcinoma of the prostate patient and ureteral obstruction, who meets the above criteria, and who is confined to his home or resides in a nursing home. In this clinical scenario, each month the urologist arranges care for his patient to be provided by other non-physician providers at the facility or at the patient’s home and bills for this management service using the chronic care management codes.