CODING & DOCUMENTATION

Fam Pract Manag. 2017 Mar-Apr;24(ii):36.

Writer disclosure: no relevant fiscal affiliations disclosed.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

  • New and improved rules for chronic care management
  • Dietitian "incident-to" billing
  • Electronic wellness record problem lists

New and improved rules for chronic care direction

Q

What are the 2017 changes to Medicare's requirements for chronic care management?

A

Medicare has expanded coverage for chronic intendance management (CCM) and has relaxed some of the billing requirements. The key changes are equally follows:

  • Medicare now covers complex CCM (code 99487 for the first threescore minutes per month, and code 99489 for each additional 30 minutes per calendar month),

  • An initiating visit is required only for new patients or patients not seen within one yr prior to the outset of CCM,

  • When an initiating visit is required, add-on code G0506 is billable if beneficiaries require extensive face-to-face up assessment and intendance planning by the billing provider (as opposed to clinical staff),

  • Patient agreement to receive CCM services no longer has to be written; it tin can exist verbal and documented in the medical record,

  • Physicians are no longer required to obtain patient authority for electronic communication of medical information with other treating providers,

  • Medicare adopted CPT language to clarify that "24/vii admission" applies to urgent care needs and ensures admission to the care team, not necessarily the individual physician,

  • Medicare no longer specifies how providers must share continuity of care documents,

  • Medicare at present requires timely electronic sharing of intendance programme information within and outside the billing practice, only non necessarily on a 24/vii basis, and allows transmission of the care programme past fax.

For more than information about the changes, see "New Codes, New Payment Opportunities for 2017," FPM, January/February 2017.

Dietitian "incident-to" billing

Q

Should a registered dietitian's services be billed "incident to" a physician'due south services?

A

It depends on the service rendered and the payer. Medicare allows a registered dietitian (RD) to provide most services in continuation of a physician's program of intendance every bit incident to the doc'south service as long every bit all other incident-to requirements are met. Examples include intensive beliefs therapy for obesity when ordered past a primary care physician and provided within the physician's office past an RD who qualifies equally auxiliary personnel to the physician. RDs may too provide an annual wellness visit (alone or every bit part of a squad) when working nether directly physician supervision and inside the state-specific scope of practice rules. Y'all should verify individual payers' policies.

Incident-to billing rules practise not utilize to Medicare billing for diabetes cocky-management training or medical nutrition therapy services. Nevertheless, in general, an RD may non be the sole provider of the diabetes self-management preparation service, and a physician who provides other Medicare services may beak for the unabridged self-management service as long as the programme is accredited. Merely an RD, nutritionist, or hospital that has received reassigned benefits from an RD or nutritionist can bill for medical nutrition therapy.

Electronic wellness record problem lists

Q

If my electronic health record (EHR) pulls the patient's problem list from past visits and adds it to my current assessment, should I include all of those problems when considering the level of medical controlling?

A

No. Just those that affected direction decisions at the electric current encounter are pertinent to medical decision-making (eastward.grand., a patient'due south controlled hypertension has little to no affect on handling decisions if a patient presents with sore throat). Y'all should be able to change the documentation to include but the problems addressed at the current see. See the CMS website for more than information on appropriate EHR documentation and related coding concerns.

To meet the full commodity, log in or purchase access.

About the Writer

show all author info

Cindy Hughes is an independent consulting editor....

Writer disclosure: no relevant fiscal affiliations disclosed.

Reviewed past the FPM Coding & Documentation Review Console: Kenneth Beckman, MD, MBA, CPE; Robert H. Bösl, MD, FAAFP; Marie Felger, CPC, CCS-P; Thomas A. Felger, MD, DABFP, CMCM; Emily Hill, PA-C; Joy Newby, LPN, CPC; and Susan Welsh, CPC, MHA.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments beneath. While this section attempts to provide authentic information, some payers may not accept the advice given. Refer to the current CPT and ICD-x coding manuals and payer policies.

Copyright © 2017 by the American Academy of Family Physicians.
This content is owned past the AAFP. A person viewing information technology online may brand one printout of the material and may employ that printout but for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in whatsoever medium, whether at present known or afterwards invented, except equally authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

MOST Contempo ISSUE

FPM E-Newsletter

Sign upwards to receive FPM's free, weekly due east-newsletter, "Quick Tips & Insights."

Sign Up At present