99184-Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling.
Chronic Care and Complex Chronic Care are two new subheadings under the Evaluation and Manangement Chapter of codes. Chronic care management services are described as services given when the medical and/or psychosocial needs the of patient require establishing, implementing, revising, or monitoring of the patient’s care plan. Patients must have two or more chornic continuous or episodic conditions that are expected to last at least twelve months, or until the death of the patient. The chronic conditions must also put the patient at risk for death, functional decline, or acute axacerbation or decompensation.
99490-Chronic Care management services, at least 20 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month. If reported time is less than 20 minutes it should not be reported separately.
Complex Chronic Care Management Services must meet all guidelines of Chronic Care Management but the services must be for at least 60 minutes and for a condition which requires a moderate or high level of medical decision complexity. If the care plan remains little or no change (only a medication is changed) these services should not be reported. The Evaluation and Magenemt Services chapter gives specific reasoning on determining the level of medical decision (straightforward, low, moderate, or high). Some specialities do have speicif guidelines as two determining how complex the chronic care management is. Adult cases commonly involive a patient receiving 3 or more prescription medications and some additional sort of therapy. In pediatrics it commonly refers to patiens receiving 3 interventions (medication, nutritional support, some type of therapy). Most patients eligible for this sort of care need coordination from many specialties and services, are unable to perform daily living activities, have psychiatric and other comorbidities, and need support for access to care.
99487-Chronic care management services for at least 60 minutes per month that meet all Complex Chronic Care Guidelines. Report this code for 60-89 minutes of service.
99489-Each additional 30 minutes of complex chronic care. This is an add-on code that can only be used after the first 89 minutes of complex chronic care services were rendered. It would be reported with the 99487.
For example if the complex chronic care services were for less than 60 minutes, no complex chornic care codes would be reported. However if 120 minutes of complex chronic care was given in a calendar month the reported codes would be 99487, 99489X2.
Advance Care Planning is also a new heading for which providers can report time spent face to face with another qualified healthcare provider and patient, or family member. This time can be spent cousleing, discussing advanced directives and/or completing standard forms. Examples of standard forms may include; Health Care Proxy, Durable Power of Attorney for Health Care, Living Will, and Medical Orders for Life Sustaining Treatment (MOLST). The patient does not have to be present if the physician is speaking with the family member. These codes are not used for active management of a problem and can be billed with some E/M (visit codes). Specific codes that can be reported together are listed in the CPT manual.
99497-First 30 minutes of advance care planning, face to face with patient, and/or family members.
99498-Each additional 30 minutes of advance care planning. This is an add-on code that can only be used after the first 30 minutes of complex chronic care services were rendered. It would be reported with the 99497.
For example the physician is discussing and helping the patient’s spouse complete forms for Durable Power of Attorney for Health Care. The physician spends a total of 45 minutes with the patient’s spouse for advance care planning, the codes used would be 99497 and 99498.
Many times when a patient is receiving Chronic Care or “End of Life” Care there is much more time spent with the patient, monitoring their situation, coordinating their care and helping the family members understand and prepare for measures that may need to be taken. These codes were formulated to specifically cover that time spent by the physician caring for those patients. It is important that physicians receive reimbursement for the time they spend caring for their patients and these codes should be used to detail how that time was spent.