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Chronic Care Management (CCM)
Chronic care management services are at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. This CCM service requires:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
In these services, the physician does not have to be face-to-face with the patient. Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (like number of illnesses, number of medications, repeat admissions, or emergency department visits) or the typical patient profile in the CPT prefatory language.
A list of common chronic conditions include, but aren’t limited to:
- Alzheimer’s disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer
- Cardiovascular disease
- Chronic Obstructive Pulmonary Disease (COPD)
- Depression
- Diabetes
- Hypertension
- Infectious diseases like HIV and AIDS
Complex CCM
Complex chronic care management services, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
- Establishment or substantial revision of a comprehensive care plan
- Moderate or high complexity medical decision making
- 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure). Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes additional to the first 60 minutes of complex CCM services during a calendar month.
*CCM and Complex CCM differ in the amount of clinical staff service time provided, the involvement and work of the billing practitioner, and the extent of care planning performed.
Synergy's Chronic Care Management Software
Our chronic care management software provides you with all the tools necessary to provide your patients with quality care while also keeping an efficient workflow.
CCM notes are easier than ever with our straightforward design. The bulk of the page is where you can write down notes about you patient. Below that section, you have the appointment timer. Since Medicare requires you to have a minimum care management time, this upfront timer allows for you to easily measure your appointment progress. At the bottom of the page, you can list the appropriate diagnoses to help create a running medical history for the patient. There is also a search feature if you forget the ICD-10 code.
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Sources:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management
Learn more about CCM Codes