HCCIntelligence Recording: 2022 Coding & Policy Impacts-December 2021-Advanced Coding Opportunities Resource

Advanced Coding Opportunities Resource

Pdf Summary

This document serves as a comprehensive guide for Home-Based Primary Care (HBPC) providers and staff to navigate advanced Medicare coding opportunities beyond traditional Evaluation and Management (E/M) codes. These specific codes facilitate better alignment with the complex needs of home-bound patients and help maximize Medicare Fee-for-Service reimbursements.<br /><br />Key Sections:<br />1. **Transitional Care Management (TCM)**: Assists patients' transition from inpatient facilities back to their homes, significantly reducing 30-day readmissions. This requires detailed documentation, including an interactive patient contact within two days of discharge and a face-to-face visit within 7-14 days. Codes 99495 and 99496 apply.<br /><br />2. **Chronic Care Management (CCM)**: Manages patients with two or more chronic conditions, necessitating at least 20 minutes of clinical staff and provider time per month. Key codes include 99490, 99491, 99487, and 99489, focusing on comprehensive care plans and documented patient consent.<br /><br />3. **Principle Care Management (PCM)**: Focuses on managing a single high-risk chronic condition, requiring structured patient data recording and thorough care management. Relevant codes include G2064 and G2065.<br /><br />4. **Online Digital E/M Services (E-Visits)**: Captures provider-patient digital interactions for acute symptoms management over a week-long period. Specific codes are 99421, 99422, and 99423 for physicians, and 98970-98972 for non-physician health professionals.<br /><br />5. **Advance Care Planning (ACP)**: Involves in-depth discussions with patients about their healthcare preferences if they become incapacitated, using codes 99497 and 99498.<br /><br />6. **Prolonged Services**: For extended patient care beyond usual times associated with E/M codes, both face-to-face (99354, 99355) and non-face-to-face (99358, 99359) services are included.<br /><br />7. **Additional Services**: Covers a variety of other services such as Smoking Cessation Counseling, SBIRT (Substance Use Disorder Screening), Anticoagulation Management, Behavioral Health Integration (BHI), Cognitive Assessment, and more, along with their pertinent codes.<br /><br />The document emphasizes correct documentation and time-tracking to ensure compliance and avoid “double-counting” time towards multiple services. For further insights, clinicians are advised to refer to the Centers for Medicare & Medicaid Services (CMS) resources and the HCCIntelligence™ tools for detailed guidelines and support.

Keywords

Home-Based Primary Care

Medicare coding

Evaluation and Management

Transitional Care Management

Chronic Care Management

Principle Care Management

Online Digital E/M Services

Advance Care Planning

Prolonged Services

Medicare Fee-for-Service