How to get paid for complex care coordination

Q: While reviewing the 2013 Current Procedural Terminology book, I came across new codes for complex chronic care coordination services. Can you explain these codes to me?

A: These new codes were designed to incentivize care coordination and improve healthcare delivery to patients with chronic diseases. The Centers for Medicare and Medicaid Services considers these services as bundled into the services to which they are incident-to, however, not separately payable.

The codes cover services provided to an individual residing in a home, domiciliary, or assisted living facility and are addressed by multiple disciplines and community service agencies. The reporting individual provider is the one who directs the management and/or coordination of services as needed for all medical conditions, psychosocial needs, and activities of daily living.

Care coordination may include:

• communication with the patient, family members, and caregiver decision-makers regarding aspects of care;

• communication with agencies serving the patient;

• patient and/or family education to support self-management;

• identification of community resources;

• facilitating access to care as needed; and

• development and maintenance of a comprehensive plan of care directed by the physician or qualified healthcare professional.

THREE CODES

The new codes:

99487: Complex chronic coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with no face-to-face visit, (once) per calendar month.

99488: First hour of clinical staff time directed by a physician or other qualified healthcare professional with one face-to-face visit, per calendar month.

99589: Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (list separately in addition to code for primary procedure).

The first hour of time is defined as 31 to 74 minutes. Time is not recorded on the day the patient has an evaluation/management visit with the provider.

These codes can be used when doctors of different specialties confer to treat patients with one or more chronic diseases. Care coordination includes services such as care plan oversight (99339–99340), prolonged services without direct face-to-face contact (99358–99359), anticoagulant management (99363–99364), analysis of data (99090–99091), medical team conferences (99366–99368), education and training (99360–98962, 99071), telephone services (98966–98968), online medical evaluation (98969, 98944), preparation of special reports (99080) transitional care management (99495-99496), medication therapy management (99605–99607), and end-stage renal disease services (90951–90970); if performed these services may not be reported separately in the month for which 99487–99489 are reported.

The American Medical Association/Specialty Society Relative Value Scale Update Committee, commonly known as the RUC, has recommended work relative value units (wRVUs) as follows:

99487: Work RVU = 1.00

99488: Work RVU = 2.50

99489: Work RVU = 0.5

Answers to readers' questions were provided by Maxine Lewis, CMM, CPC, CPC-I, CCS-P, president of Medical Coding and Reimbursement in Cincinnati, Ohio. Send your primary care-related coding questions to [email protected].