CODING CORneR lines for these services have been extensively revised, although the codes themselves have not changed. Cms announced in the Final Rule for the 2014 medicare Physician Fee schedule that medicare will begin paying for care coordination in 2015; however, this column deals specifically with the coding guidelines, not the medicare coverage requirements. The 2014 guidelines state that complex chronic care coordination involves “developing, substantially revising, and implementing” Telephone/Internet consultation cannot be reported more than once per seven-day period. If more than one telephone/Internet session is needed during the seven-day period, the sessions should be added together and the consultant should report a single code. the care plan. substantial care plan revision might be required when a new problem or exacerbation of an existing problem requires new interventions, or when current interventions are found to be ineffective. In this situation, there is a need for more intensive monitoring, changes to the treatment regimen, and education of the patient and caregiver(s). The guidelines have also been revised to clarify that “activities of daily living” (aDls) include both instrumental and basic aDls. The guidelines state that patients who are candidates for complex chronic care coordination may be identified by algorithms (either practice-specific or published) that take into account multiple illnesses and medications, inability to perform aDls, need for a caregiver, and repeat hospital admissions or emergency department visits. The typical adult patient takes three or more medications, may receive other interventions (such as physical therapy), and has “two or more chronic continuous or episodic health conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.” (The 2013 guidelines stated the patient would have one or more such conditions.) There are different criteria for pediatric patients. Finally, the guidelines now state that the patient may require substantial assistance from a caregiver in order to comply with the treatment plan, due either to cognitive impairment or inability to perform aDls. The 2013 guidelines stated that the patient was “expected” to have problems that require moderate or high complexity medical decision making and extensive staff support. The 2014 guidelines state that these conditions are “required.” similarly, last year’s guidelines stated that a documented plan of care “should” be shared with the patient and caregiver, while the 2014 guidelines state that the plan “must” be shared. a new paragraph has been added to clarify the elements that should be included in the care plan. This is intended to be a “comprehensive plan of care for all health problems” and typically includes: • Problem list • expected outcome and prognosis • measurable treatment goals • symptom management • Planned interventions • medication management • Community or social services ordered • method for coordinating services of outside agencies and specialists • Individuals responsible for each intervention • Plan for periodic review/revision The 2014 guidelines state that complex chronic care coordination should not be reported if the care plan is unchanged during the month or requires only minimal changes, such as a medication change. With regard to service time, the 2014 guidelines state that the reporting physician or practitioner should count only the time spent by his or her own clinical staff. also, if two staff members meet about the patient, the meeting time should be THe jOuRnal OF THe HealTHCaRe BIllIng anD managemenT assOCIaTIOn 33
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