Coordination of Care Code and Requirements
Payment for the code 99490 (coordination of care for chronically ill Medicare patients) is $42.60 for 20 minutes of staff time, and it can be billed once per patient per calendar month. The top three inhibitors that may limit its use, include the following:
Despite the significance of this change, challenges remain for practices to actually obtain payments for CPT code 99490, which is intended to capture non face to face chronic care management (CCM) services, according to an article from Medical Economics.
- To be eligible for reimbursement, CCM-related services must be performed using a 2011 or 2014-certified electronic health record (EHR) system. Other members of the patient’s care team must also have access to this electronic record.
- Practices will need to devise systems to track all team members’ time spent on CCM activities covered under the code. But because most EHR systems are not currently set up to track this information (and customization may be cost-prohibitive), experts recommend practices use a paper-based flow sheet to meet this requirement for now.
- Patient consent, along with a $8 monthly copay, is required for practices to provide and bill for comprehensive CCM services. Even though the service will enable patients to connect with their care team 24/7, 365 days a year to reduce or eliminate emergency department visits and hospitalizations, it may be a tough sell, said George G. Ellis, Jr., an internist in Youngstown, Ohio, and Medical Economics’ chief medical adviser.
Your practice needs to decide is the billing of this code worth the trouble for your practice? Essentially it will be a volume question, both good and bad news. Volume will reimburse your practice for what it is currently doing free for chronically ill patients. Volume will also mean more to keep up with and that means it has to be planned and monitored.
This is a job for the practice manager to analyze, plan and implement. As in most practice decisions, do the math. What will it cost vs. what will you get reimbursed?