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Coding Corner: Complex chronic care coordination services added to E/M

July 01, 2013
Area(s) of Interest: Hospitals and Health Facilities Payor Issues and Reimbursement Practice Management 


CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.


A new evaluation and management (E/M) category in CPT® 2013 reports coordination of care for patients with chronic illnesses. Effective coordination of services among providers to manage complex conditions requires significant staff and provider time.


Codes in the new section can be reported by care coordinating providers for clinical non-face-to-face time with the patient, family and other caregivers. This includes education, communication and when determining resources and/or a care plan. The coordination activities are detailed in the coding guidelines preceding 99487–99489.


Patients with one or more chronic illnesses expected to last at least 12 months, acute exacerbation of an illness, or functional decline qualify for the use of these codes. Codes are reported per calendar month. At least one hour must be documented to claim the services. Documentation templates to record the date, time spent on chronic care coordination and the care coordinated facilitate proper documentation to support the services. The patient’s medical condition must meet the requirements stated in the coding guidelines preceding 99487–99489.


Other CPT® codes describe specific coordination or monitoring of care services not reported with 99487–99489. For example, end-stage renal disease services (90951–90970) cannot be reported during the same month as 99487–99489. The provider must determine which service type required the most time, and report those codes. A parenthetical note following 99489 lists the services that cannot be reported during the same month as 99487–99489.


Code 99487 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month describes the first hour of clinical staff time for performing complex chronic care coordination, when there has been no face-to-face visit with the patient.


Code 99488 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month describes the first hour of clinical staff time for performing complex chronic care coordination. This service includes one face-to-face encounter not separately reported. Additional, medically necessary encounters may be reported separately.


Add-on code 99489 Complex chronic care coordination services; 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) reports each additional 30 minutes of complex chronic care coordination beyond the beyond the first hour to be reported in addition to 99487 or 99488 

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