The Centers for Medicare and Medicaid-recognized the importance of including a sustainable practice to manage care for patients suffering from multiple chronic conditions in the year 2015.
Medicare leveraged Physician Fee Schedule (PFS) options for CCM services offered to patients ailing from chronic conditions.

It’s been over 2 years since the implementation of Chronic Care Management services for patients.
CMS has closely observed the outcomes of those initiatives and has come up with plans that will increase the focus and funding towards the existing Chronic Care Management programs.

Let’s Understand CPT 99490

To be able to differentiate the purpose of the old codes from the new codes, one must understand the conditions for billing under CPT 99490. Chronic Care Management Services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:

1. Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
2. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
3. Comprehensive care plan established, implemented, revised, or monitored

Assumes 15 minutes of work by the billing practitioner per month

What’s new in Complex CCM codes?

The primary limitation of CPT 99490 is the consulting time of 20 minutes, most practices felt the need to increase the consultation time for a patient.
Though CCM services resulted in positive outcomes, the results were far short of objectives.
Thus, they decided to increase the consulting time of CCM with new Complex CCM codes that can be used to provide 60 minutes of consulting in a calendar month and the duration of 60 minutes is billable.

Complex Chronic Care Management services, with the following, required elements:

1. 1. Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
   2. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
   3. Establishment or substantial revision of a comprehensive care plan
   4. Moderate or high complexity medical decision making
   5. 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

How does the billing work?

A patient must be billed either for Complex Chronic Care Management codes or the already existing Chronic Care Management code.
The same patient should not be included or billed under both the codes, that way there’s more organized workflow for billing and reimbursement.

Reporting Expectations

Chronic Care Management codes CPT 99487, 99489, and 99490 are reported only once in every calendar month by the practitioner who carried out the care management, no more than one claim per month was allowed.
In the case of Complex Care Management, each month a practitioner is expected to review patient’s health condition and classify whether the patient would still be under the procedures of Complex Care Management or the existing Chronic Care Management codes.

This is a crucial practice to establish the health outcome of the patients given the importance and assistance for chronic conditions, in addition to that practitioners are expected to meet the quality metrics that are recommended by CMS.

Implementation of Comprehensive Care Plan at a practice level

New Chronic Care Management codes stress the necessity and induce the interest in creating an individual care plan for each of the patient’s for achieving better health outcomes.
It is important for the healthcare provider to record and assess patient health information at regular intervals.

An electronic form of secure patient information needs to be generated, based on which a physician can come up with a care plan that is required for the patients.
With technology companies extending their influence in healthcare, remote patient monitoring and real-time patient data can be gathered and put to best use. Creation and execution of care plan is one of the primary responsibility of the provider to adhere to quality metrics expected by the CMS.

HealthViewX is in the business of Healthcare IT, we offer a suite of comprehensive IT solutions from Referral Management, Chronic Care Management and a holistic Care Management Platform.