Billing for Chronic Care Management (CCM)
Chronic Care Management (CCM) services (CPT 99490, 99491) offer a significant, often untapped, revenue stream for managing patients with two or more chronic conditions. Success hinges on meticulous time-tracking of non-face-to-face care coordination and clear documentation. It's essential to obtain written patient consent before starting a CCM program.
Coding for Acute Infectious Diseases
For acute illnesses like influenza or strep throat, accurate billing requires linking the diagnosis to the services rendered. For example, a visit for flu-like symptoms should link the ICD-10 code for influenza (e.g., J10.1) to both the E/M service and the rapid influenza test (CPT 87804). This clear connection demonstrates medical necessity and prevents denials.
Respiratory, Asthma, and Sleep Care Billing
Family practices often manage common respiratory conditions. Be sure to bill for services like in-office nebulizer treatments (CPT 94640) and spirometry (CPT 94010). For sleep concerns, you can bill for the interpretation of a home sleep study (CPT 95800) even if an outside company provides the device. Documentation must include a formal, signed report of your findings.
Check Supervision Rules: Payers and states have specific supervision requirements for diagnostic tests like spirometry. Ensure you are compliant to avoid claim denials.
Heart and Vascular Care Management
Managing chronic cardiovascular conditions like hypertension requires specificity in your ICD-10 coding. Use codes that reflect the type and severity (e.g., I10 for essential hypertension). You can also bill for in-office diagnostic tests like EKGs (CPT 93000 for the global service) and Holter monitor interpretation, provided you document a separate, signed report.
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