Wiki Coding CCM

[nkan88]

Good Afternoon,

I am getting mixed research when looking for what codes can be used for the 99490. I was told the dx code has to be on the HCC list that we can download from CMS. However, I cannot find any specific information on the dx codes that we can use. Can anyone direct me in the right way?

Thank you

 

[Pam Warren]

I have not read anywhere or been told by anyone (and CCM was my masters' thesis project--so I know this stuff inside out) that HCC codes are the only ones used for CCM. CCM is billed to report any chronic illness that meets the criteria per CPT (chronic, long-term, may result in death, etc.,), and not just restricted to HCC diagnoses.

However, CCM is a very good place to document any chronic conditions on the HCC list that are currently being treated that might be used by Medicare Advantage plans, and it's been recommended by CMS that you use CCM, IPPE, AWV to report all conditions for HCC purposes. That doesn't mean that you would exclude diags that are not part of the HCC list (like smoking status). Hope this helps.

 

[Ramesh B]

I have not read anywhere or been told by anyone (and CCM was my masters' thesis project--so I know this stuff inside out) that HCC codes are the only ones used for CCM. CCM is billed to report any chronic illness that meets the criteria per CPT (chronic, long-term, may result in death, etc.,), and not just restricted to HCC diagnoses.

However, CCM is a very good place to document any chronic conditions on the HCC list that are currently being treated that might be used by Medicare Advantage plans, and it's been recommended by CMS that you use CCM, IPPE, AWV to report all conditions for HCC purposes. That doesn't mean that you would exclude diags that are not part of the HCC list (like smoking status). Hope this helps.

Hello Pam,

Thank you very much for the details, i have one question regarding the Sign Off, Who need to sign off the medical record for CCM, You answer is much Appreciated

Thanks

 

[sdunaway1]

Pam,

Can you please help me understand this, I work for a neurosurgeon's office and we were recently given a lower fee schedule due to having 26 % healthier pts compared to other neurosurgeons in our area. We have since appealed and have received an exception due to not coding the comorbidities accurately. I am putting together an education session for the providers in our office and am now understanding that not all comorbidities give us credit for the risk adjustment score per patient. Can you please direct me to the correct appllicable HCC code list so we are coding correctly and getting the credit that we deserve for seeing such an unhealthy population?

We have received and found in research such contradicting information - Can you please help??

Thank you ,

Stephanie