Outpatient Facility Coding Alert - 2018 Issue 5
Care Management: Consider These Components, Manage Chronic, Complex Care Coding
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Article Overview
This article explains the main compliance and documentation topics involved in chronic care management and complex chronic care management reporting. It is aimed at coders, compliance staff, and clinicians who support E/M care management services, and it covers patient eligibility concepts, care plan elements, time tracking, and broader CPT-related requirements that affect reporting.
Why This Topic Matters
Accurate care management reporting depends on understanding who qualifies, what documentation must be present, and which service components and related activities affect coding. The article helps readers recognize the operational and compliance issues that can influence whether chronic care management services are supported in the record.
Article Sections
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First, Know Who Is Eligible
Discusses the general patient eligibility concepts for chronic care management and the types of chronic conditions addressed in the article. It also references the broad risk-based criteria tied to these services.
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Second, Document a Care Plan
Reviews the care plan documentation elements associated with chronic care management reporting. The section focuses on the types of information the plan is expected to include.
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Third, Know When It's Time for CCM to Turn Complex
Covers the time-based aspects of chronic care management and complex chronic care management reporting. It also discusses related complexity and workflow considerations mentioned in the article.
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Fourth, Follow Even More CPT® Guidelines
Summarizes additional CPT-related requirements and limitations that affect reporting of chronic care management services. The section also touches on practice infrastructure and service categories discussed in the article.
What You Will Learn
- The general eligibility framework for chronic care management services
- The documentation elements expected in a care plan
- The broad difference between chronic care management and complex chronic care management
- The types of additional practice requirements that can affect care management reporting
- The operational challenges involved in tracking and documenting time for these services
Who Should Read This
- Medical coders
- Compliance staff
- Physician practices
- Clinical staff involved in care management
- Pediatric coding professionals
Codes Discussed
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