Wiki 99484 Care management services for behavioral health conditions

[tobester]

I hope someone can shed some light on this code. This code is per month. I am auditing a behavior health provider and he billed this code 70 members for one DOS. Does anyone know if this code is cumulative? Can the provider take all the clinical staff notes from the month and review all at the same time and bill?

99484 - Care management services for behavioral health conditions, 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:

• initial assessment or follow-up monitoring, including the use of applicable validated rating scales,
• behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes,
• facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and
• continuity of care with a designated member of the care team.

Any help would be greatly appreciated.

 

[Troykall1]

I hope someone can shed some light on this code. This code is per month. I am auditing a behavior health provider and he billed this code 70 members for one DOS. Does anyone know if this code is cumulative? Can the provider take all the clinical staff notes from the month and review all at the same time and bill?

99484 - Care management services for behavioral health conditions, 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:

• initial assessment or follow-up monitoring, including the use of applicable validated rating scales,
• behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes,
• facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and
• continuity of care with a designated member of the care team.

Any help would be greatly appreciated.

We are working under a grant right now to develop CoCM Collaborative Care Management billing in conjunction with our integrated care clinic. This code has never come up before in the grant discussions but it sounds right up the alley with what we are doing. I have presented this question to the grant holders and sponsors so I will let you know if I find out any info for you. You know it will be complex when this one code has a page of information about it in CPT.

 

[Troykall1]

I hope someone can shed some light on this code. This code is per month. I am auditing a behavior health provider and he billed this code 70 members for one DOS. Does anyone know if this code is cumulative? Can the provider take all the clinical staff notes from the month and review all at the same time and bill?

99484 - Care management services for behavioral health conditions, 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:

• initial assessment or follow-up monitoring, including the use of applicable validated rating scales,
• behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes,
• facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and
• continuity of care with a designated member of the care team.

Any help would be greatly appreciated.

They were fast at the CoCM grant. It is cumulative to 20 minutes. These codes can be used this way. Our providers do review for CoCM and then send them to the consulting psychiatrist. I bill those all on the 28th of each month. The grant experts sent me to the NCCI edits for cpt 99484. Between the cpt manual and the NCCI edits I do not see why all 70 couldn't be billed on the same day.