As a content creator for carcodescanner.store and an automotive repair expert, I’m pivoting my expertise in diagnostics and systematic problem-solving to the realm of healthcare coding, specifically care coordination. Just like diagnosing car issues requires understanding complex systems, navigating healthcare reimbursement demands clarity and precision. Let’s tackle some frequently asked questions about care coordination coding to demystify this process.
For more general information, you can also check out our PDCM FAQs.
Understanding the Basics of Care Coordination Coding
Q: Many healthcare tasks that were previously done via phone are now online. Does time spent completing online forms, like CPS intake, court, or school documents, count as care coordination?
A: Yes, absolutely. Whether a care team member spends time on the phone or completing online forms, the time and effort dedicated to these tasks remain the same and are considered part of care coordination. The method of communication doesn’t change the nature of the work if it’s directly related to patient care coordination activities. Think of it like diagnosing a car issue – whether you use an old OBD-II scanner or a cutting-edge wireless tool, the diagnostic work is still valuable.
Q: How can healthcare providers get reimbursed for the time spent coordinating patient services with external providers and resources, such as home health, specialists, and community services?
A: To receive reimbursement for non-face-to-face clinical care coordination within a patient-centered medical neighborhood, a care team member needs to accumulate at least 31 minutes of dedicated time within a single calendar month. Once this threshold is met, you can submit either code 99487 or 99489, depending on the total time spent and specific coding guidelines. Just as a mechanic meticulously tracks time spent on different repair tasks for accurate billing, healthcare organizations should implement internal workflows to diligently capture and track each care coordination contact to reach the minimum time for claim submission. This systematic tracking ensures all billable time is accounted for, maximizing appropriate reimbursement.
Q: Which billing codes are appropriate when a Primary Care Physician (PCP) care team member and a Specialist care team member discuss a patient’s care plan?
A: In collaborative care scenarios where both a PCP and a Specialist care team member are involved in discussing and coordinating a patient’s care plan, both team members are eligible to bill using the Care Coordination codes (99487, 99489), provided they each independently meet the time requirements and service criteria. This recognizes the value of interdisciplinary communication and coordination in delivering comprehensive patient care. Similar to how multiple mechanics might collaborate on a complex car repair, each contributing their expertise, both PCP and Specialist input is valuable and billable under care coordination when appropriately documented.
Q: Can time spent sending portal reminders for preventive care, like mammograms (addressing Gaps in Care), be included in care coordination time?
A: No, unfortunately, sending out routine reminders, even for essential preventive services like mammograms, is generally considered part of standard day-to-day operational activities and is not included in billable care coordination time. While crucial for patient care and proactive health management, these automated or routine tasks fall under general administrative overhead, not the intensive care coordination services captured by codes 99487 and 99489. This distinction is similar to the difference between routine car maintenance reminders and dedicated diagnostic or repair work – reminders are essential but not billable as specialized services.
Examples of Included and Excluded Care Coordination Activities
Examples of activities that ARE included in time spent on care coordination (without direct patient interaction):
- Finding and securing drug financial assistance programs: This involves dedicated research and application processes to alleviate the financial burden of medications for patients, requiring significant time and effort beyond routine tasks.
- Applying for patient assistance programs: Similar to drug assistance, navigating and completing applications for broader patient assistance programs is time-consuming and directly benefits patient access to care.
- Confirming treatments are indicated for a specific diagnosis: This requires clinical knowledge and time to review patient records, treatment protocols, and potentially consult with specialists to ensure the prescribed treatments are evidence-based and appropriate. This is akin to a mechanic confirming the correct repair procedure for a specific car model and issue.
- Coordinating the initial prescription fill with a specialty pharmacy: Specialty pharmacies often handle complex or high-cost medications, requiring extra coordination to ensure timely and accurate prescription fulfillment, insurance approvals, and patient education.
Examples of activities that are NOT included in time spent on care coordination (without direct patient interaction):
- Checking patient benefit coverage: Verifying insurance benefits, while necessary for billing and patient communication, is considered a standard administrative task, not complex care coordination.
- Obtaining Prior Authorizations: The process of securing prior authorizations from insurance companies, although sometimes lengthy, is also classified as an administrative function rather than direct care coordination.
- Completing routine documentation: Standard documentation tasks, such as progress notes or routine data entry, are essential for record-keeping but are not considered billable care coordination activities.
Care Coordination Coding Scenario: A Practical Example
Let’s illustrate how care coordination time accumulates with a realistic scenario:
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Month: October 2024
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Activity 1: Care team member contacts a home health agency to schedule in-home visits and conduct a home safety assessment for a patient recently discharged from the hospital. Time Spent: 11 minutes.
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Activity 2: Care team member contacts a Durable Medical Equipment (DME) provider to arrange for the delivery of home oxygen (O2) for a patient with respiratory issues. Time Spent: 10 minutes.
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Activity 3: Care team member contacts the Department of Health and Human Services (DHHS) to explore and assist the patient with accessing community resources for legal aid related to housing issues impacting their health. Time Spent: 10 minutes.
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Total Care Coordination Time for October: 11 minutes + 10 minutes + 10 minutes = 31 minutes.
In this scenario, the care team member has accumulated a total of 31 minutes of care coordination activities within the month of October, meeting the minimum time requirement for submitting a claim using care coordination codes 99487 or 99489, depending on the specific requirements and total time accumulated.
Disclaimer: The information provided here is for informational purposes and should be reviewed in conjunction with the latest CPT (Current Procedural Terminology) guidelines and Centers for Medicare & Medicaid Services (CMS) regulations. Healthcare providers are responsible for ensuring all services are billed in accordance with CPT and CMS guidelines. Coding and reimbursement rules are subject to change, and it is crucial to stay updated with the most current information from multi-payer representatives and official sources.
