CPT changes a start, but more could be done

The Current Procedural Terminology (CPT) code changes in place in the 2008 Physician Fee Schedule improve the ability of physicians and other providers to document their telephone evaluations and management services, but they don't go far enough, according to the Case Management Society of America (CMSA).

The current schedule includes codes related to the delivery of case management services, but these have been given a Status N, which means they are not payable by Medicare.

So CMSA is working with the Centers for Medicare & Medicaid Services (CMS) in support of providing Medicare reimbursement for these codes.

Case managers work directly with patients in support of medical management and health care coordination, including providing health adherence assessment, education, and adherence monitoring during the discharge process.

A number of health care organizations have established or piloted programs in which discharge planners or case managers have called patients at home some days or weeks post-discharge to assess their health and continued treatment adherence. The CMS codes acknowledge the importance of such telephone services.

The three non-physician codes, issued for telephone services, include these:

• 98966

Telephone assessment and management services provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days or leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion.

• 98967

11-20 minutes of medical discussion during telephone assessment and management services.

• 98968

21-30 minutes of medical discussion during telephone assessment and management services.

There are three similar codes established for telephone evaluation and management services provided by a physician.

All six of these codes are Status N, but they have Relative Value Units associated with them, meaning that private payers may cover them.

CMSA says the solution is to request funding for these six codes so providers will be able to integrate case/care managers support of the Medical Home concept, such as the Medicare Medical Home Demonstration, pay for performance programs, and various collaborative models of care which CMSA and other regulatory agencies are discussing.

For more information about this issue of CPT coding for case management, contact Michel Lee, manager of member and chapter services at mlee@acminet.com or call (501) 225-2229, ext. 1120.