Chronic care management coding updates for 2020

Medicare continues to support and encourage chronic care management (CCM) in practices  to lower costs and decrease hospitalizations. But practices that have implemented CCM programs have reported several frustrations, including having more work to do than what’s being reimbursed, and challenges with care plan creation and content.

The Centers for Medicare & Medicaid Services (CMS) Final Rules for 2020 have brought some relief in the form of new payment opportunities for CCM, pending a more comprehensive update from the AMA CPT Editorial Panel.

1)     G2058 is a HCPCS code to capture additional care management time up to 60 minutes

If moderately complex care is provided and it involves a physician or other qualified health professional, consider using the Complex CCM code, 99487. Use 99489 for each additional 30-minute increment of Complex CCM.

2)     Guidance for care plan creation has also been issued to make it less prescriptive.  In general, there are a number of elements that are suggested, but not required.  Remember that a quality comprehensive care plan includes most of these elements, but it should be patient-centered and tailored to the patient’s goals.

The comprehensive care plan for all health issues typically includes, but is not limited to, the following elements:
● Problem list.
● Expected outcome and prognosis.
● Measurable treatment goals.
● Cognitive and functional assessment.
● Symptom management
● Planned interventions.
● Medical management.
● Environmental evaluation
● Caregiver assessment
● Interaction and coordination with outside resources, and practitioners and providers.
● Requirements for periodic review.
● When applicable, revision of the care plan.

3)     For Medicare patients, a substantial revision of the care plan change is no longer required in order to submit 99487 and 99489 for Complex CCM.

4)     Transitional Care Management (TCM) may be delivered during overlapping calendar periods of CCM. Make sure that services delivered are not used to support both codes. In other words, no double dipping!

— Dr. Samuel L Church, MD, MPH, CPC, CRC FAAFP, and Cindy Hughes, CPC, CFPC