How Physicians Can be Paid for Coordinating Care

Practices are now able to bill for coordinating care of people who have been discharged from a hospital or for those who have more than one chronic condition, according to American Medical News.

These new codes are meant for “transitional care management” and “complex chronic care coordination” and have been in effect since the beginning of 2013. They do not require practices to become patient-centered medical home or become part of an accountable care organization, although the American Medical Association hopes practices use them as a means to such an organization.

Commercial insurers are still deciding which codes will be covered and how much money will be offered. At the moment, Medicare will pay about $600 million for practices to move a patient from a hospital, although it will not pay for complex chronic care coordination.

The article details how doctors can be reimbursed, and what the codes can be used for:

For instance, the transitional care management codes should be used when a practice takes care of the issues of a patient returning home or going to another care setting from a hospital or skilled nursing facility. Both codes, 99496 and 99495, require a physician to have and document some kind of medical discussion, although not necessarily in person, with the patient or their caregiver within two business days of discharge. The higher-level code, 99496, calls for a face-to-face visit within a week. For the lower-level code, 99495, the face-to-face visit may be within two weeks. The other set of new codes can be used for patients a physician or insurer considers in need of significant care coordination services outside of usual face-to-face visits. These services can be provided by a physician, but coding designers say they are a better fit for nurses or others staffers within their scope of practice. These codes cover designing care plans, linking patients with multiple medical professionals and community service agencies and organizing, and attending medical team conferences.

The code 99487 should be used if the patient is not actually seen by the physician, but instead if other practice staff spend an hour over a 30-day period on care coordination involving that patient. Code 99488 includes this hour of care coordination time and a face-to-face visit. Code 99489 should be used for 30-minute increments over the initial hour of care coordination. Medicare considers these codes as bundled with other services, but commercial payers may cover them.