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Advanced Coding Opportunities
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Pdf Summary
The document provides comprehensive guidance for healthcare professionals on various Medicare reimbursable services focusing on Transitional Care Management (TCM), Chronic Care Management (CCM), Advance Care Planning (ACP), and several others.<br /><br />**Transitional Care Management (TCM):** TCM services facilitate the transition of Medicare beneficiaries back home or to other facilities post-discharge. It involves coordination of care (via phone or electronically) within two business days of discharge and requires a face-to-face visit within 7-14 days. Codes 99495 and 99496 are used for billing based on the complexity of care.<br /><br />**Chronic Care Management (CCM):** CCM services cater to patients with two or more chronic conditions that are expected to last at least 12 months. It requires a minimum of 20 minutes of clinical staff time each month, focusing on a comprehensive care plan. Various codes like 99490, 99487, and 99489 are used based on the complexity and time spent.<br /><br />**Advance Care Planning (ACP):** ACP involves face-to-face discussions about advance directives with patients and/or caregivers. It is billable using codes 99497 and 99498 for sessions lasting at least 16 minutes and 46 minutes, respectively.<br /><br />**Prolonged Services Without Direct Patient Contact:** These services cover extensive time spent on patient care that isn't direct, such as reviewing medical records or phone consultations. Codes 99358 and 99359 are used depending on the time spent.<br /><br />**Prolonged Services With Direct Patient Contact:** These services involve extended face-to-face interaction with patients beyond the typical visit time, coded with 99354 and 99355 based on the time.<br /><br />**Cognitive Assessment and Care Plan Services:** For patients with cognitive impairment, code 99483 covers a comprehensive evaluation and the creation of a care plan, which must include ten specific service elements.<br /><br />**Smoking Cessation Counseling:** Medicare reimburses for counseling sessions aimed at helping patients quit smoking, documented with codes 99406 and 99407.<br /><br />**Anticoagulation Management:** Includes INR monitoring for patients on warfarin therapy. Codes 93792 and 93793 document the training and management aspects.<br /><br />**Interprofessional Internet Consultation:** These new consultation codes (99446-99449, 99451, and 99452) facilitate interprofessional exchanges and are payable under specific guidelines.<br /><br />**Virtual Check-ins:** Remote evaluations and brief communications via phone or electronic means are billed with codes G2010 and G2012, ensuring patient consent and comprehensive documentation.<br /><br />The document also discusses 2019 changes to the Medicare Physician Fee Schedule, including the removal of specific documentation requirements and the introduction of interprofessional consultation codes, among other updates. <br /><br />It concludes with sources and further reading links for detailed guidelines on each service mentioned.
Keywords
Medicare
Transitional Care Management
Chronic Care Management
Advance Care Planning
Prolonged Services
Cognitive Assessment
Smoking Cessation
Anticoagulation Management
Interprofessional Consultation
Virtual Check-ins
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