Chronic Care Management Gets a New G-code

Healthcare Training Resource
February 14, 2014 — 1,133 views  
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The Center for Medicare and Medicaid Services or CMS has identified, through the creation of the new G-code, the critical role that proper care management systems play in reducing costs and improving performance. The physician community has voiced its opinion, in that the current E/M codes fail to quantify the non-face-to-face time spent in managing chronic care patients, including medical homes which focus on extensive care management to raise the quality of health care services for critical care patients. The current E/M codes do not account for the time spent on the non-face-to-face work that is being provided, especially for those patients with multiple chronic conditions.

Separate payment for chronic care management

As the concerns being raised were genuine, the CMS issued a separate payment for the chronic care patients. The new G-code is reserved only for those who are suffering from two or more conditions that are expected to last twelve months or more or until the patient dies, and places the patient at increased risk of death, acute exacerbation/decompensation or function decline. Isolating these patients reduces risk as well as decreasing costs for the Medicare program.

This new G-code is individually payable for Chronic Care Management Services. These services must be provided for at least twenty minutes within a thirty-day billing cycle.  Services include:

  • Reconciliation of medication.
  • Continuation with a designated care practitioner.
  • Oversight of management of medications by the patient themselves.
  • Care transition management.
  • 24/7 access to the health provider for the patients with acute chronic care need.
  • Management of all types of chronic conditions including the assessment of the patient’s medical, psychosocial and functional needs.
  • Full freedom of communication between the patient and care giver.
  • Patient-centered care plans.

Before any provider distributes the bill for chronic care management, the recipient must be informed of the services and consent to receive them. This agreement must be documented within the patient’s medical record, and may be revoked by the patient at any point in time.

The CMS has opened this up for public comment, and will continue to develop the standard in 2014, with implementation expected in 2015. CMS will likely employ them with the CY2015 Physician Fee Schedule rulemaking.


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