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Chronic Care Management

  1. The guidelines state moderate or high complex MDM. Should we use the E&M guidelines for MDM to determine this?

    Answer:
    Yes, the E&M guidelines for MDM are applicable, since chronic care management (CPT 99490) is included within the E&M classification of codes. Updated 6/9/2017
     
  2. Code G0506 (comprehensive assessment of and care planning for patients requiring chronic care management services-list separately in addition to primary monthly care management service). What would Medicare expect to see in the documentation to warrant “Comprehensive Assessment” on top of the IPPE, AWV or E&M to establish CCM?

    Answer:
    Documentation of CCM must include a status assessment and plan for all chronic conditions identified within the E&M service (including the IPPE or AWV). Updated 6/9/2017
     
  3. How is CCM handled in an OB/GYN practice during pregnancy? Should the OB report CCM during pregnancy and, if so, would the patient need to agree to CCM services by OB/GYN? This question applies to providers in the same group practice who utilize a common EMR.

    Answer: CCM services can only be performed and billed by one provider within the group in a month’s time, and cannot be billed on the same date as another E&M service by the same provider.  If the OB/GYN is assuming the primary care for this patient, then a new consent must be obtained from the patient, authorizing the OB/GYN as the provider who will be providing and coordinating her care. Updated 6/9/2017

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