Innovations and Efficiencies in Home-Based Care: HCCI Solutions Suite for NPHI Members-Advanced_Coding

Advanced_Coding_Opportunities

Pdf Summary

The resource guide is designed for Home-Based Primary Care (HBPC) providers and staff to enhance their understanding of advanced coding opportunities beyond Evaluation and Management (E/M) codes that cater to the complex needs of patients, enabling maximized Medicare Fee-for-Service reimbursement.<br /><br />Key advanced coding areas include:<br /><br />1. **Transitional Care Management (TCM)**: Involves post-discharge oversight and care for Medicare beneficiaries transitioning home or to a non-skilled nursing facility. TCM aims to reduce unplanned 30-day hospital readmissions by facilitating timely follow-up and improved care, with specific CPT codes (99495, 99496) for post-discharge visits requiring moderate to high medical decision-making.<br /><br />2. **Chronic Care Management (CCM)**: Targets the management of two or more chronic conditions through at least 20 minutes of care coordination each month by clinical staff under a physician's direction. Essential elements include patient consent, comprehensive electronic care plans, and structured patient information recording using Certified Electronic Health Record Technology (CEHRT).<br /><br />3. **Principal Care Management (PCM)**: Focuses on managing a single high-risk disease necessitating detailed care plans and 24/7 access to care. Different CPT codes (99424-99427) cover various nuances of PCM.<br /><br />4. **Online Digital E/M Services (E-Visits)**: These are intended for acute symptoms or problems addressed through digital communication platforms over seven days. Suitable for established patients, these services provide a remote evaluative function that does not link to recent in-person visits.<br /><br />5. **Advance Care Planning (ACP)**: This involves face-to-face discussions about future healthcare preferences, potentially integrated with annual wellness visits. Specific CPT codes (99497, 99498) apply depending on the time spent.<br /><br />6. **Prolonged Services**: They include face-to-face and non-face-to-face services exceeding the typical time for related CPT codes. Documentation of time, nature of services, and reasons for extended care is essential.<br /><br />7. **Cognitive Assessment and Care Plan Services**: Focuses on assessing and planning care for patients with cognitive impairments and includes standardized testing and safety evaluations, detailed through CPT code 99483.<br /><br />Additional services like **Smoking Cessation Counseling**, **SBIRT Services for Substance Use Disorders**, **Anticoagulation Management**, **General Behavioral Health Integration**, and **Interprofessional Consult Services** are also detailed, with relevant CPT codes and documentation requirements.<br /><br />Providers are encouraged to incorporate these coding opportunities effectively, backed by comprehensive documentation and patient consent, to ensure accurate billing and reimbursement. For further updates, HBPC providers are advised to refer to the respective CMS resources and the HCCIntelligence Resource Center.

Keywords

Home-Based Primary Care

advanced coding

Medicare Fee-for-Service

Transitional Care Management

Chronic Care Management

Principal Care Management

Online Digital E/M Services

Advance Care Planning

Prolonged Services

Cognitive Assessment