Reporting CCM and TCM Codes with E/M Codes

by  Chris Woolstenhulme
June 1st, 2022

When reporting CCM or TCM codes, you will only get reimbursed for what is allowed.  The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time spent with the patient toward the CCM service if it is counted toward E/M.  The time cannot be counted twice.

CCM and office visits are not interchangeable, see the following rationale:  Office and other outpatient E/M services, such as 99202-99215, require different elements of medical decision making than CCM codes.  During the office visit, a patient is seen for a diagnostic visit, reviewing notes, and tests while evaluating the risk of the patient. Look at the required elements with the following E/M code types.

Required elements for 99204 – office visit: 

Care management services are just that, you are managing the care of an illness.  The required elements are listed in the AMA code description as follows:

“Required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death.  The condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. ”

Access to Care & Care Continuity is an important part of Chronic Care Management (CCM), CCM providers are expected to provide the following: 

NOTE: “Beginning CY 2022, RHCs and FQHCs can bill CCM and TCM services for the same patient during the same time period”

Please refer to MLN -Chronic Care Management Services for more information. 
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf

Reporting CCM and TCM Codes with E/M Codes. (2022, June 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/reporting-ccm-and-tcm-codes-with-e-m-codes-37078.html

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