It is not a new concept to any health professional that we all spend some time coordinating the care of our patients, whether it is directly or indirectly related to the service we are providing. It is part of our job, part of treating and caring for the whole patient. What is a “new” concept is that we may start getting paid for our efforts!
The Obama administration announced recently that beginning in January 2015 they will pay monthly fees to MDs who manage care for patients with two or more chronic diseases like heart disease, diabetes and depression. “ Paying separately for chronic care management services is a significant policy change” said Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services. Officials said such care coordination could pay for itself by keeping patients healthier and out of hospitals. With the new initiative, Medicare will adopt some of the techniques devised by health maintenance organizations and Early intervention programs which already have service coordination as a paid service. According to an August 17th NY Times article, doctors will draft and help carry out a comprehensive plan of care for each patient who signs up for one. Under federal rules, these patients will have access to doctors or other health care providers on a doctor’s staff 24 hours a day and seven days a week to deal with “urgent chronic care needs.” The Obama administration rejected pleas from doctors to relax or delay “the 24/7 requirement,” saying it was essential.
As part of the new service, doctors will assess patients’ medical, psychological and social needs; check whether they are taking medications as prescribed; monitor the care provided by other doctors; and make arrangements to ensure a smooth transition when patients move from a hospital to their home or to a nursing home. Doctors can expect to receive about $42 a month for managing the care of a Medicare patient. Care management services can be provided only if patients agree in writing. Patients will pay about 20 percent of the $42 fee, the same proportion as for many other doctor services.
Despite the fact that the fee is ridiculously low (monthly subscriptions to magazines often cost more), it is a symbolic win and acknowledgment. Hopefully it will lead the way for all health professions to start to bill and be paid for the many hours they put in coordinating the care of their patients. Ironically, there have been little known and little used case management service CPT codes for qualified non physician healthcare professionals available for years. The codes listed below are not recognized by Medicare. However, other health plans may elect to cover them and now hopefully more and more will. Here are a few:
Medical Team Conferences – If you participate in medical team conferences for a patient’s care, you may use medical team conference CPT codes to report 30 minute or longer meetings that meet certain criteria
99366 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by non physician qualified health care professional
99368 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by non physician qualified health care professional
Criteria -The following criteria must be met to report the team conference codes:
- A minimum of three qualified health care professionals from different specialties or disciplines who provide direct care to the patient must participate in the reported team conference.
- No more than one individual from the same specialty may report 99366-99368 at the same encounter.
- Reporting participants must be present for the entire team conference.
- Reporting participants shall have performed face-to face evaluations or treatments of the patient, independent of any team conference, within the previous 60 days.
Reporting participants should record their role in the conference, contributed information, and subsequent treatment recommendations. The time for the team conference starts at the beginning of the case review and ends at the conclusion of the review. Record keeping or report generation time is not included. However, the time is not limited to the time that the participant is addressing the team or patient/family.
Physicians will be able to report 99367 for a medical team conference with an interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more. Physicians are referred to evaluation and management codes for one comparable to 99366.
Telephone Assessments –There are three codes for reporting services provided over the telephone. The telephone assessment codes are for “non-face-to-face assessment and management services provided by a qualified health care professional to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient.”
98966 Telephone assessment and management service provided by a qualified non physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967 11-20 minutes of medical discussion
98968 21-30 minutes of medical discussion
Certain conditions preclude the use of the codes:
- They cannot be used if the patient is seen within 24 hours of the phone call or during the next available urgent visit appointment, or if the patient was seen within the previous seven days.