This page addresses follow-up questions and additional information pertinent to our webinar Beyond E/M Leveling.
The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: What date of service should be used on the practitioner CCM claim and when can the claim be submitted?
A: For complex CCM (99487, 99489), billing practitioners should report the service code(s) at the conclusion of the service period.
For CCM services furnished by clinical staff and directly by practitioners (99490/ 99439, and 99491/99437), the billing practitioner may report the service at the conclusion of the service period.
Practitioners may also choose to submit the claim after completion of the service time for the code. When the time threshold to bill is met, the practitioner may choose that date as the date of service, and no need to hold the claim until the end of the month.
CMS FAQ Practitioner Billing for CCM Services 8/16/22
Q: For patients with multiple chronic conditions, including behavioral health conditions, how should one decide when to bill CCM services versus BHI services?
A: CCM involves care planning for all health issues and includes systems to ensure receipt of all recommended preventative services, whereas BHI care planning focuses on individuals with behavioral health issues, systematic care management using validated rating scales, and does not focus on preventative services. Certified EHR technology is not required for BHI as it is with CCM.
The code that most closely describes the service furnished should be reported.
CMS FAQ Billing Medicare for BHI Services
Q: Can multiple specialists report PCM services (99424/99425 and 99426/99427) in the same month for a patient with multiple chronic conditions? Each specialist is independently managing a single complex chronic condition.
A: PCM is not limited to patients with only one condition. It is possible to receive PCM services from multiple specialists for multiple conditions simultaneously (e.g. a cardiologist for heart failure and medical oncology for pancreatic cancer).
Reference: CPT instructions pg. 48
Looking for additional information on this topic?
Tamara Jones, RHIT, CPC, CPMA, CRC
Senior Coding Quality Auditor
Tamara brings over 15 years to Haugen’s team of Coding Quality Auditors & educators. She began her career as a denials specialist, instilling the importance of accuracy from the start! Tamara has a very investigative, analytical mindset which guided her through the roles as claims and coding managers, finding her fit as an auditor. Tamara enjoys reviewing coding assignments, digging into the clinical documentation, and working with clients to share opportunities for improvement. She has identified opportunities for clients to improve clinical documentation, identify deficiencies in processes or guidelines, and provide education to help their staff excel!