1. Keys to Billing Care Coordination and Consolidated Billing Rules Lynn M. Anderanin, CPC, CPMA, CPC-I,CPPM, COSC

2. Agenda • Coordination Care – Chronic Care Management – Transitional Care Management – Care Plan Oversight – Home Health Certification/Recertification • Consolidated Billing Rules – Radiology – DME

3. CPT- Surgical Package Definition • Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical) • Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia • Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals • Writing orders • Evaluating the patient in the post anesthesia recovery area • Typical postoperative follow-up care

4. CPT-Care Management Services • Patient has two or more chronic continuous or episodic health conditions that are expected to last at least 12 months, or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

5. CPT-Care Management Services • 99487- Complex chronic care management service – 60 minutes of clinical staff time in a calendar month – Establishment or substantial revision of a comprehensive care plan – Moderate or high complexity medical decision making

6. CPT-Care Management Services • +99489- Complex chronic care management service – each additional 30 minutes of clinical staff time in a calendar month – Management of a comprehensive care plan – Moderate or high complexity medical decision making

7. CPT- Care Management Services • 99490- Chronic care management service – At least 20 minutes per calendar month – Management of comprehensive care plan

8. Chronic Care Management CMS Fact Sheet • https://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network- MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

9. CMS-Chronic Care Management • Practitioner Eligibility – Physicians and the following non-physician practitioners may bill CCM services: – Certified Nurse Midwives – Clinical Nurse Specialists – Nurse Practitioners – Physician Assistants • Not within the scope of practice of limited license physicians and practitioners such as clinical psychologists, podiatrists, or dentists. • Not a NCCI edit to surgery with 90 day global

10. CMS- Chronic Care Management • Examples of chronic conditions include, but are not limited to, the following: – Alzheimer’s disease and related dementia – Arthritis (osteoarthritis and rheumatoid) – Asthma – Atrial fibrillation – Autism spectrum disorders – Cancer – Cardiovascular Disease – Chronic Obstructive Pulmonary Disease – Depression – Diabetes – Hypertension – Infectious diseases such as HIV/AIDS