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Sickness billing format for client for teams

so we will go ahead and get started um we're really excited to have Ashley Schwartz here today to talk about team-based care billing and coding uh to get started do you mind putting it in uh presentation mode Ashley perfect we'll just do a few housekeeping slides so that you're prepared to submit this for CME so on the screen are instructions you need to text um 66503 to the number listed here ideally before the end of the day today or before tomorrow and uh you had to complete the evaluation online by March 19th we're also going to send a handout out to everyone following the call as well that will include these instructions so that you can refer back to the number and have the link to complete the online evaluation I'm gonna go next slide and we are offering CME we're off in Madison CME so one uh AMA category one credit nursing CE one ancc contact hour pharmacy CE for one ACP ER and dietetics cpeu as well so if you are in any of those disciplines you are able to go ahead and claim um one hour credit for attending this presentation next and then just with our disclosure so Dr Lauren Ashman our program director will be presenting the second half of this presentation I'm billing for non-face-to-face care and she does have um Stacks in publicly traded companies uh in Abbott Abby Johnson American Co op um okay and with that I will hand it over to Ashley to go over some of the elements of team-based care billing and coding with you thank you Ashley thank you thank you so much Jackie and I'd like to thank Dr Ashman for inviting me to come speak to all of you today my name is Ashley Schwartz I am a licensed social worker uh and I work with the Michigan Institute for Care Management and transformation my goal today is to give some high level basics of team-based care billing and coding and uh feel free to put some questions in the chat because they do know towards the end we'll be able to do some q a thank you so just to reference this presentation uh was materials based off of our foundational Care Management and codes uh and billing opportunities course developed through a collaborative effort within Michigan Institute for Care Management transformation uh throughout the presentation today I'll be highlighting some resources that are available under our website for future needs so I want to set the expectation that this presentation does build upon team-based care focusing on reimbursement for Care Management Services specifically related to Blue Cross Blue Shield of Michigan and Priority Health however some details discussed May uh be like other payers um so you might have questions related to you know Medicare Medicaid some of those other you know specific hap payers but we're really focusing on Blue Cross and Priority Health as well so today's objectives are goal is to identify members of a care team Define Healthcare coding and billing describe two common Healthcare coding classifications explain the importance of documenting within the encounter and illustrate how a care team member may impact risk adjustment in the financial model of practice so I want to set the foundation from the agency for healthcare research and quality the primary goal of medical teamwork is to optimize the timely and effective use of information skills and Resources by teams of healthcare Professionals for the purpose of enhancing quality and safety for patient care so team-based care what does it take it takes a holistic person focused in family-centered approach care coordination across settings and organizations a common set of quality outcome metrics and reimbursement for Care Management Services and care coordination so there's been a big shift from fee for service to value-based reimbursement and of course billing the encounters contributes to the success of value-based reimbursement so now we want to talk a little bit about the importance of productive interactions and sustainability so it starts with those conversations many many productive interactions with patients can lead to improve outcomes we know this that and it is measured at a population level but not only that you have the ability to bill for those interactions that you're having with your patients and their caregivers uh this will sustain the support of Care Management through payments and successful incentive programs so we want to introduce your care team members so at the top you will see we have our licensed Professionals of course we have our physicians we have our advanced practice providers also apps registered nurses pharmacists Master social workers registered dietitians and certified diabetic educators we also want to highlight our unlicensed professionals we have our importance in our clinics such as our medical assistants as well as our community health workers and some people the community health worker is a new role for some individuals but we are really highlighting them because they are wonderful in our community and can help our patients and our practices so with that being said our unlicensed professionals will work under excuse me a written protocol or also known as standing order signed by the physician or app in your offices uh on our website at micmt we do have an example document what we call our scope of service document that is available for you if this is something you're interested in having we also want to highlight those extended members that we don't always think about the front desk staff are schedulers our billers and coders they are so important as we think about who is in our care team it is truly a team effort so billing and coding chain of accountability so we I always think of the football analogy that the physician is similar to our quarterback the quarterback leads the team we have our advanced practice practitioners we have our care team members our licensed and unlicensed and our billers and coders if we're not all working together our practice will not be successful and our patients won't have what they need so defining coding so we just wanted to quickly review the difference between coding and billing and claims there is sometimes a confusion of really what does that mean so Healthcare coding it involves the billable information from the health care record in reviewing clinical documentation Healthcare billing uses those specific codes to create the insurance claim and bills for patients and then we have our health care claims so that's where the the Health care billing and coding intersects to form the backbone of the actual practices Revenue so we want to highlight the importance of documentation and really what is the trigger for coding and billing well that starts with you it starts with the time of what is actually happening so we use the example well if it's not documented there's no proof it happened so clinical documentation Improvement is a process that continually looks for ways to best maximize the health care record in targeting with the goal of providing and completing an accurate picture of a patient's condition and the care services they receive most often specific to the setting where services are provided so as an example as a licensed social worker I'm working in the practice I'm assisting the patient I'm on the phone of the patient I set my interventions up and then I document it right there in the medical record for proof so we want to talk a little bit about coding for special specificity ICD-10 CPT and hick pick codes so we all know that documents should documentation should be as specific as possible and drill down so as I mentioned what did I do what did the patient say things like that but we really want to be specific to the coding as well and again it's mandated it by HIPAA specific specificity and coding has a significant impact on hedis metrics and risk scores as well so as I mentioned we've really moved away or are moving away from that fee for service and we are moving into that value-based reimbursement excuse me that's where risk scores can also be very important so I have just a few examples on the screen of what I mean so chronic obstructive asthma with acute exacerbation we don't just say COPD uh hypertension heart disease with heart failure we're no longer just saying heart failure hypertension again just some highlighting some examples and I know you are all here as you work within the mct2d cqi model and so obviously we can see on the right hand side we all know how important it is to really be specific when we're talking about our diabetic patients as well so we have you know our Diabetic Type 1 type 2 and really narrow uh bringing it down as you can see in the right example so now I want to talk a little bit about care team procedure codes um we uh are highlighting the 12 procedure codes and these start with um the g9001 which is the Coordinated Care initial assessment and the g9002 which is the maintenance these are also known historically as a face-to-face code however since uh covid actually there has been the open guideline that if a patient is unable to come into the office and has declined any sort of video Telehealth visit that these codes can be done telephonically specifically with the g9002 we do want to highlight that if it is greater than 45 minutes you can quantity bill we have our group education so our nine eight nine six one and six two you'll see that uh those two type those two codes are based upon the number of patients that are participating in your group education and they are a maximum 30 minutes so you'll see one verse two in the total time and again those are eligible for quantity billing we have our phone services so the 9966 through the 98968 those are super important opportunities so when you're reaching out to patients as a care team member as I mentioned we have our license and our unlicensed and the phone service codes are available for um for outreach from our medical assistants and our community health workers we do want to highlight that those individuals are eligible to use these phone Services Under the Blue Cross guidelines however I do want to highlight that priority help does not allow they have a set list of their qualified Health Care Professionals as well they are time limited as you can see and then we have our care coordination codes so these are those non-uh patient directed codes so the patient is not involved these might be examples of reaching out to as it says your patient center Malco home neighborhood so maybe reaching out to Home Health Care maybe reaching out to some transportation services those resources that are going to allow that patient to get some help um and again these are time-based codes I also want to highlight these are per a calendar month so for example the 487 must be within 31 to 75 minutes and it is within a calendar month team conference the g9007 is a super important code because it does give you the opportunity to connect back with those Physicians your you know your quarterback to talk about the patient maybe there's some concerns that the patient identified at home and we need to follow back up with the patient to address the treatment plan so that is an opportunity for you as a care team member and the physician to have a discussion and be able to bill for that service the g9008 and this is a physician director code and this is when a physician can communicates with another physician on the care team member so maybe the primary care doctor is reaching out to the cardiologist or the endocrinologist and having that conversation about a treatment plan that is a billable service and then lastly we have our s0257 and that is your counseling for advanced directives so we're going to talk a little bit more about the codes later in the presentation but I did want to highlight the codes for you so billing for care team member activities is so important billing for your services and being paid for the services places of value on what you do and helps the patient billing along with the care team incentive programs is how team-based care can be sustainable and sustainability comes from engaging a minimum number of patients in a day so at micmt we do have a recommendation that you have a minimum of four encounters on an average per half day eight or more and as we look at sustainability that is going to continue to grow and later as I mentioned we are also going to talk a little bit about what that could look like a day in the life we want to be sure you have a mixture of types of encounters so as I mentioned you we have those face-to-face opportunities if the patient's right there in the office we also have those telephone services so as a patient you know exited to the office and we want to follow up with them in a few days or set up a time a weekly Outreach you have those phone services and again as I mentioned you have telephone and virtual and of course lastly billing consistently for services I can't say that enough so to highlight the process for uh Revenue we of course as I mentioned document the encounter in the patient's chart assign an appropriate code we submit the claim electronically interpret the payer's response and the prepare for post make excuse me prepare for post payment actions audits documents request so you can see as I've gone through the first few slides how our care team is so important as a licensed social worker I'm going to document my my time with the patient I'm going to select the appropriate code so if I had that phone Outreach I would select the appropriate time-based code and then I'm going to submit the claim but am I going to submit the claim or as I'm working collaboratively with my biller coder and then we have the payer's response so for for example Blue Cross what is the payer's response and then prepare for those post payments so they'll return on investment as well as understanding if there's any additional needs so what are the key takeaways from the first few slides team-based care is derived from The Chronic care model and is completely patient-centered sustainability of team-based care is identified uh excuse me is identified important members of The Care team our nurses our social workers our dietitians assigning appropriate classification of codes the g9001 g9002 and then documenting Services therefore billing and billing is consistent so this next portion I'm going to talk a little bit about billing and the optimization opportunities it is so important to match a diagnosis with what's going on so care team members can take an opportunity to make sure that the patient's diagnosis are correct by reviewing the problem list and making recommendations to our quarterback our provider other optimization opportunities could include preventives care chronic care support our social determinants of health and then HCC hierarchy care coding so this slide is going to give you just an example of what it might look like if working uh with a patient so I'm um from a billing perspective or doing an Outreach for gaps in care so we're reaching out to the patient and then is there a determination if this patient has a chronic disease or not we're going to determine if yes or if no and what kind of service am I providing so I'm providing Outreach maybe because the patient hadn't had a mammogram and so I'm going to do that Outreach because there's that Gap so now I would have an idea of what appropriate code I could use for some of this Outreach that I'm doing and um another super important code that we hear a lot is this counseling and care coordination of care we've had really good feedback that this is a a super valuable code to use when you're just unsure uncertain or if the patient doesn't have a specific chronic condition but you're doing some Outreach maybe for that sdoh so when to use a z code for sdoh so this is just highlighting the importance of the the availability of Z codes um we're we're enhancing you know we're doing those assessments with our patients to determine if there is a barrier or a need related to you know Transportation financial support housing food insecurities so there are codes available should you need them based on the uh outcome of that screening of an sdoh and this is just an example um a resource that it will take you to list all of the Z codes available and again uh the most common Z codes and for the purposes of billing we did want to highlight that um historically that homelessness has been one of the top top Z codes used and there are several payers such as Blue Cross and Priority Health that are offering incentive plans surrounding the sdoh and the usage of the Z codes so now we're going to show from a clinician's perspective what a day in the life could look like so this this is just an example of a schedule because we do recommend that all care team members should have a set schedule there could be blocks throughout the day um so you'll see right here at the morning you know we we encourage huddles with our care team members to prep for the day um and then you'll see that in the beginning of the day this individual did transition of care so that 8 30 to 9 you're working through your list who's been in the hospital and discharged and let's do some of the Outreach to get those out of the way for the day and then now we have by nine o'clock we have a new patient visit coming in excuse me and then as we work through our day we have a slight block from 10 30 11 so maybe we're we're catching up on some documentation we're doing maybe some follow-up calls um based on uh patients had you had seen earlier in the day or earlier in the week um and then again already at 11 we have a new patient visit by lunchtime we have some opportunity you know of course take your lunch take care of yourself but then maybe have some opportunity for some additional follow-up maybe you need to do some Outreach to those resources that you need to set up so care team members should should make sure to comprehensively bill for all their interactions the frame of mind should be that all interactions are billable so the question is how do I bill not should I bill and again this is just another way to look look at a schedule so morning Black versus an afternoon block and I want you to ask yourself how close does this mirror your experience and do you see any barriers from what your day in the life looks like versus what this looks like I mentioned earlier that we from a sustainability perspective we encourage you to have at least four uh encounters per half day and so you're going to see just looking at this um that within the first uh half hour they had a team conference with the physician on three separate patients in this asterisk just means multiple encounters um and then as I'm walking through just this morning block we had that initial uh patient visit and then we had some additional care coordination Outreach again uh g9002 that's that maintenance follow-up with a patient and then a team conference with the physician so just highlighting some of the encounters um you can see that you and and as we get further into the presentation we're going to walk through some scenarios but you can see that multiple codes can be billed in multiple days or excuse me on the same day so this is just the summary of what the day looked like for that clinician this right here showed 14 billable activities for the day now again please be mindful that this is uh an ideal situation it your schedule might look different so applying Care Management codes to practice review and understand your billing codes and their application in your work to perform within the practice select the appropriate billing code in various scenarios and documentation is key so again here's just a highlight highlighted list of all of our codes that we've uh I mentioned earlier in the presentation and now we're going to go ahead and jump into some scenarios uh that those codes could be utilized so I've mentioned transition of care chronic conditions chronic disease management social determinants of Health those specialty and Primary Care interactions gaps in care as well as substance abuse so this is an example of what a Care Management workflow could look like we start off with an initial Outreach or maybe a cold calling patients based on gaps reports we have a team conference to talk about some of those patient interactions or maybe we're talking with our physician about who would be an important person to follow up with today so that morning huddle or even midday we have the physician interaction so Dr Dr Rachel uh recommended that uh maybe a care manager follow-up with Dr uh with Mrs Smith or and or maybe Dr Jones contacted Dr Rachel about A cardiology consult or treatment intervention we have our group education opportunities so maybe our diabetic educator is having some group sessions this afternoon we have our social worker who also has a consult to follow up and again this could be multifaceted in your practice you might have all of those different types of individuals or maybe you only have a social worker or a nurse in your practice and then we have the the communication between the nurse and the social worker so again just an example of what a Care Management workflow could look like so now let's jump into a team-based care scenario so Miss Smith completes an in-person office visit with Dr Jones at 9am during that visit Dr Jones refers Miss Smith to Eric the nurse care manager for diabetic management Miss Smith indicates she can consents to me Eric today Erica Ms Smith discussed previous diabetic management including diet medication risks symptoms and home support Erica Miss Smith established a care plan related to medications diet and coordinates her follow-up appointments to see Dr Jones in six to eight weeks and completes weekly telephone calls with Eric this time uh total time was 40 minutes so let's think about those codes that we previously talked about and what code would we use for this scenario so if you said g9001 you are correct uh this opportunity was that it was a face-to-face visit and it lasted longer than 30 minutes so it resulted in a care a Care Management plan that all team members and and the patient agreed to so let's jump forward Miss Smith contact Eric in two weeks reporting symptoms of dizziness lightheadedness blurried vision and some times of confusion Miss Smith and Eric review her medications and she reports her recent blood sugars from her CGM Eric generates the report and contacts Dr Jones regarding concerns Dr Jones modifies Miss Smith's treatment plan medications and recommends a one-week follow-up and then and then excuse me Eric contact Smith to educate on changes of medication regimen and side effects that occur Eric assist was scheduling a one-week follow-up appointment and schedules a call with Miss Smith in two days so you're going to see at the top we had a 15 minute uh phone call between Eric and Miss Smith we had a 10-minute team conference with Dr Jones and Eric and then we had a 15-minute secondary follow-up call between Eric and Miss Smith so think about your codes so we have multiple codes that we could bill for this interaction we have our 21 to 30 minute 98968 because we had a 30 minute call between the two calls that equal 30 minutes we had an interaction between our provider our and the uh Eric to talk about her her treatment plan I do want to highlight that that conversation is required to be face to face or via telephone or video you cannot have message EMR messaging portal messaging or emails in order to build this code and then we also had that Eric generated the CGM report and prepped it for Dr Jones to review and interpret the CGM data so we can also include our CPT code for that the 95251 so an N you add three three separate uh distinct services yeah so documentation suggestions so we want to always recommend that documentation should include the following at minimum and you can kind of see here everybody's EMR looks a little bit differently we all have a little bit different uh templates involved and I want to highlight that different insurance companies different payers have recommended different requirements and so this is a a high level documentation uh goal um and you can kind of see it highlights the duration of visit the type of visit who was involved from a patient maybe the caregiver as well as maybe the physician consent for services you'll notice earlier in our scenario I did highlight that Miss Med did agree to to talk to Eric what was the treatment plan we want to highlight our care plan so what did the patient agree to and what what was our goals ideally um add the patient smart goals if possible if they've been identified and when it's appropriate and then lastly I did want to highlight the CGM report and again we recommend and understand that different organizations have different templates so this is just a high level brand uh the sensor placement and removal dates analysis I've heard from certain organizations they can take a screenshot and put that right there in in their report and then of course the physician interpretation so key takeaways the billing codes can be utilized in many common clinical workflows within your office setting uh but is not limited to at least transition of care social determinants of Health those interactions between primary care and specialties gaps in care and substance abuse be sure to appropriately document your encounter in detail and ing to the billing rule specified by the individual insurance carrier so now I've included some frequently asked questions that I do know I believe towards the end of our call today we're going to do some q a based on um questions that were received during the registration process but I did want to highlight just some of the questions here um specifically related to the PD Sam calls so can a keratin member bill for Advanced Care planning yes they can uh and uh it is not required to have a referral from a physician to Bill that s0257 can I get reimbursed for time spent coordinating services with providers so we talked a little bit about that the home health specialty offices Community Resources that is that 99487 and 99489 and it is a non-face-to-face clinical interaction with the neighborhood so it is required to be at least 30 minutes in a calendar month some of the things included in that are finding drug Financial programs applying for patient assistance programs coordinating the prescriptions within a specialty pharmacy but I do really want to highlight what is not included checking benefit coverage prior authorization and completing your documentation and then lastly just the top question talks about who is available and allowed to bill for pdcm and yes unlicensed care team members such as medical assistants and community health workers are able under Blue Cross Blue Shield are able to bill for those services uh please be mindful that other insurance companies such as Priority Health does not allow um medical assistance or community health workers to vote for those codes they do have additional qualified health care professional requirements now uh lastly just want to highlight some of our resources at micmt we have uh our website you can see some screenshots we have billing and within billing we have the specific codes we have reference documents additional FAQs available to you we also offer multiple events and webinars available for continuing education as well as training opportunities um for uh for for all of you and now here's again just some additional resources available to each of you um as I mentioned our training opportunities we have our patient engagement course introducing based care course and our foundational billing course which parts of this presentation were derived from and now I believe I'm gonna turn it over actually can we actually pause for a minute and go through some of the questions in the chat before we move on um to Dr ashman's portion yes sorry I couldn't see the chat while I was presenting so I do apologize sure I will go through oh and I can go ahead third and read them to you um so the first question is like do these codes apply to the Medicare Advantage population as well yes okay perfect it isn't I do want to say it is important um and I do know Lori bachter is also on the line from Blue Cross um but I've worked really closely with her and I will say they will always recommend anybody should check coverage benefits coverage before billing for pdcm and there is a list of groups that have opted out of the pdcm program uh and that is also a reference document available on the website as well as with Blue Cross okay great um the next question is will there be any changes to allowing the phone calls with the end of the public health emergency when you say allowing the phone calls are you referring to the face-to-face inner the the g9001 and 2 being allowed uh to be done via telephone versus in person if that is the case um it is officially changed since the public health emergency um yeah and Lori I believe you gave us the answer to that question at least with those two codes and the answer was yes they can still be billed telephonically as the law if the patient doesn't feel comfortable coming in or if they don't have transportation and it is documented in the chart correct okay um with the 9948 oh sorry go ahead okay um with the 99487 if it is billed per month do we Bill those each individual instance even if it doesn't meet that time requirement so this is going to be based on your individual workflows within your organization but no you shouldn't be billing them that's where we recommend having those conversations um with your billers and coders um some organizations have it on the back rule engines on the back end so the clinician would do what they you know follow their normal steps every time and then on the back end it stops IT and once it goes It goes out at that end of that calendar month regardless if it meets the time requirement um for a team member to build the phone codes do they need to have Care Management training there's been an impression that in order to use the Care Management codes they must be a recognized care manager with Blue Cross Blue Shield or Priority Health so yes for the the 12 codes that we talked about today uh it for Blue Cross for the payers specifically Blue Cross and Priority Health they do require individuals to complete intro to team-based care uh within six months of billing the Care Management codes okay and that is for both uh licensed and unlicensed Care Professionals okay um should we use a z code if doing preventative um gaps Outreach if the patient does not have a chronic condition or diagnosis that is uh yes you can use the Z codes as well as the code I mentioned um earlier um I'll have to take a quick peek I don't remember it off the top of my head but Peggy I will uh put that code in the chat fantastic thanks Ashley you're um to fill these codes does every patient need to be engaged in Care Management so I guess when we're thinking about Care Management we you know ultimately we want our patients to be engaged in consenting for services uh there is opportunity to build these codes if a patient declines Services um but I guess I think the the important piece is understanding what engaged in Care Management needs um if a provider reviews and signs off on an ER follow-up call made by an M.A can the phone codes be billed such as 98966 [Music] if a provider reviews and signs off on an ER follow-up call that's made by a medical assistant can the phone codes be billed such as 98966 so the medical assistance making the call but the provider reviews and signs off on it after a patient's discharge from the ER thank you I know that we do allow the telephone codes um to be billed when someone has been into the ER I don't see an issue with that because ultimately the The Physician is the one that's responsible right um so yeah I would say yes was that an inpatient question or an ed question it was an uh ER m yeah we also again be mindful that the medical assistant should have um to complete Services you know should take the training as well do patients ever have to pick up the out-of-pocket cost for these Care Management codes due to either deductibles or co-pays so there is no cost share associated with these telephone or with these procedure codes for pdcm uh one thing I do want to caution however is if you are rendering a service to a member that is considered a hosting member and those are people that live in Michigan but have coverage through another Blues plan the benefits are based on that other Blues plan and so ultimately more than likely they will assess cost share for their enrollees this pdcm and no cost share only applies to Blue Cross and Blue Shield of Michigan and rollers um there's a comment I've noticed as the care manager the CGM report 95251 does not always get paid when they build a code but the code it does get paid when the doctor does with a visit with the patient I'm going to lean on Lori if she can take that um unfortunately I was remembering on you because I don't know that code um yeah so the CGM codes I mean our understanding is that you know they're the all codes are built under the direction of the physician right so I think in in the example that you just provided if if it's the if the rendering provider is not the billing provider then maybe that's why it's getting denied but I think that might be an example you'll have to take back to the payer to determine the differences between the two examples okay okay um so a g9001 or g9002 and a g9007 can be billed on the same day if a patient was seen in the office and then a discussion was had with the provider afterwards to discuss the plan is that accurate okay technically yes however in most cases you're not billing a g9001 and a g9002 on the same patient the same day um again you want to make sure for that initial assessment that g9001 you can meet the requirements for that I find in most examples it's a you're picking one or the other because you haven't met the the guidelines for that g9001 so you're most likely billing a g9002 but absolutely can those codes be billed simultaneously okay and it will actually either one of those with the zero zero seven correct and we highly encourage that because that's that conversation with the patient um excuse and then conversation with the provider okay and then let's say there's a little bit of questions about the g9008 code someone said that the physician Coordinated Care oversight Services was a code billable by The Physician at the initiation of Care Management as an enrollment fee this was agreed to by the patient physician and Care manager with all three parties present and in agreement um they wanted to know when this changed and then also just interest in like reviewing the g9008 code a little bit in more detail so um in this case specifically Brenda is not wrong and there is the physician Coordinated Care oversight code um has always been that initial a referral for a patient a care manager and a physician and specifically to Priority Health that is their guideline that the patient should be involved in that referral so there has been no change however Blue Cross also allows that interaction between a specialist or maybe the PCP and the patient and and prior to in hospital visit the PCP is talking to the paramedics at the home or that patient has a home paramedic coming out to do checks um that conversation to prevent maybe a hospitalization is also a billable opportunity under that g9000 or g9008 and please Lori you can jump in here as well if I'm you actually have it all you've covered it all so an app cannot build the g9008 code guys that is strictly a physician mdbo code okay thanks Laurie um the question to billing charges get applied to the patient's deductible we already covered that there's not a cost share there g9001 um can this be billed with the patient um if they don't come into the office or does it not have like the video option that is correct it can be done telephonically as long as the it's documented that the patient doesn't have the options to perform a video visit or doesn't feel comfortable coming into the office it can be completed telephonically but it must be documented okay um just a couple more engagement Care Management currently working with the care manager do they have to be working with the care manager in order to build these 12 codes or if an MA is setting up home O2 or Home Care can the coordination of care code be built yes and yes um so yes obviously we want to encourage engagement in in Care Management um and long longitudinal care management opportunities but you can build a follow-up you know such as a telephone code um to really uh work with the patient and encourage the patient to participate but there could be opportunities that you're providing a resource the patient had a positive sdoh and you're providing a resource but there's no additional needs so then you're maybe only having one or two phone calls with the patient so you're using the telephone calls and then yes um if a patient if a medical assistant is coordinating care to set up homo too that's when you would use those care coordination codes the 99487 and 89 but just be mindful that it is a requirement of at least 31 minutes in in a calendar month okay and then the Care Management training it only needs to be completed one time within the first six months of billing correct yes okay uh you are required to have longitudinal care you know longitudinal education um and that can look a little differently so if you are a licensed professional you are required to get one you know professional education uh for your licensure so that counts towards that as well but for your medical assistance community health workers um we do require um in addition uh they don't have that licensure requirement so there is opportunities for eight hours by providing uh completing the educational webinars that we offer a webinar such as this would be appropriate things like that okay um all right I know you're saying only a physician can build the g9008 does that mean that apps if a physician is over them they're not allowed to Bill it is only Physicians and with on mute it should only be a physician billing okay so only Physicians can build Genesis is bcn allowing g9008 to be used for Ed prevention and collaboration like bcbsm is it is my understanding that um bcn for the pdcm program is following the same billing guidelines as bcbsm so the answer to that would be yes yes wonderful primary care for primary care physicians for Primary Care yes okay if care planning and care coordination occurs between a pcpm or PCP care manager and a specialist team-based care care manager but it is not 31 minutes how can we bill for this you can't you can't okay and go ahead oh I was just gonna say just be mindful of the time requirement that is a part of the CPT guideline okay the last question can g9001 be billed as the same on the same day as a hospital follow-up visit uh with the per with the physician or how's the other one um Mary was that with a physician that you were asking about yes so yes if the patient is being seen by The Physician for a follow-up appointment and the patient is being seen by a care manager to initiate care for for Care Management Services and they complete it yes a g9001 can be built okay we are here are our questions thank you very very much Ashley and Laurie we really appreciate it and thanks everyone for being so engaged and asking um all these types of things I'm sure it's very helpful for everyone on the call to hear the answers to this we're going to turn it over to Dr Ashman um to go over billing for non-face-to-face care doctor do you want to share your screen so that you can um control your slides and go through them [Music] or do you want to um leave them as oh we are viewing your screen now okay you're perfect yep we can see them I can't hear you great though well I wish I could um it's just cutting out a little bit got a headphone here and I just um not really okay it just got better try keep talking and I'll see if it stays all right and if not I'm gonna call in with the phone much better now thank you so much um I just want to say thank you that was such a wonderful presentation as a physician I feel so grateful to the rest of our care team for doing all of the billing and coding work so that I don't have to know all of those codes so I'm going to just narrow in on what might be more interesting if you're a nurse practitioner physician assistant or physician thinking about how you can optimize care with patients in between visits and then we'll pull this all together in terms of building these codes along with the ones that you just heard about so you should see codes to know and we're going to talk today about the online digital e m codes which are 99421-423 the Telehealth CPT codes which are 99441 through 99443 and CGM interpretation so I'll give you a for a first example of one of my patients and this is JG she's 62. she's type 2 diabetes she takes semi-glutide metformin and Glipizide and we've prescribed her as CGM she sees a nutritionist in our practice as well and we receive her lab results and see that her A1C has now increased from 6.4 to 7.8 but I don't have any visit availability so certainly I could use any of the Care team codes and I could defer that education back to a staff member but I can also decide to call this patient back myself to have this discussion and so she sends me a portal message and says Dr Oshman I'm worried about my A1C do you think we could change my semi-glue tied to that new medication you keep telling me about so the first thing that we're going to think about is how to access her CGM report and we can have our staff work with us in a variety of different ways to get this information for the physician or qualified health professional to review but she's going to attach her seven-day food log and her CGM report and my ma is going to root that to me for review and then what you're going to see here is that there's a couple of different items well move for you so we can see her time in range and we can see that she's 88 percent time in range and 12 percent above we can see her glucose patterns and identify some barriers maybe around mid-morning and lunch with increased glucose and then we even get some interpretation considerations maybe we want to think about her meals and snacks high in carbohydrates or adjusting medication and so we're going to get in that CGM report some opportunities to work with our patient so thinking about CGM interpretation and billing we're thinking about a minimum of 72 hours needed so if our patient returns this report to us and there's only two days worth of data we cannot bill for that this must be performed by a physician or qualified hcp Healthcare professional which could be nurse practitioner PA or clinical nurse specialist and like you already heard can only occur once per month but this is not required to have a face-to-face visit that code is 95251 and the Medicare rvu non-facility is 1.02 and the average is 97 so again this is a real opportunity for us to do great work with our patients in between office visits and also get paid for our work reviewing their CGM the documentation for CGM varies by payer but in standard fashion we're going to talk about why why did we order the CGM and typically that indication is going to be some element of poor glycemic control we want to do an assessment and interpretation and you are welcome to just put a screenshot of that report in your progress note and then talk about what your recommendations and plan are so we've assessed this patient we know where they may benefit from changes and then what is our plan again typical documentation that we might provide and so we analyzed this patient CGM we know she's adherent to her meal plan and her diet log there's not a whole lot I want to change and so rather than waiting for my next scheduled visit I'm sending her a portal message with my recommendation Dear Mrs G I agree with you you'd benefit from that new medication to zepatide I'm going to send it to your Pharmacy please message me if it's covered and we can review safe use and so in this case she reads my message she's going to get this new medication and I give her some instructions for that so this is an example of using our online digital evaluation and Management Service codes and these are for online digital evaluation and management these are not Telehealth codes this doesn't involve audio or video communication these are just digital codes with communication for our patients and they can be billed for up to a seven day period with cumulative time during seven days so you can imagine with this patient we went back and forth several times and so our cumulative time was 11 to 20 minutes and we could build 0.5 rvus for this I'm going to go real quick because we just have a couple of minutes here but we need to make sure that the patient has initiated requests so I couldn't ask her to talk with me and then build this code if I'm just reaching out for her test results but because she reached out to me with a request to change a medication that's considered to be the patient reaching out to me and we need to make sure we have verbal consent and so these are two disclaimers from two practices I've worked at both of them are different both of them inform the patient that we're going to be billing for these services and so again these are messaging codes they don't relate to a visit we just had so if the patient then came in to see me the next day I would remove this code and it does not include staff time only physician and qualified health care professional time I'm going to just move to the meet here in the last two minutes and Skip some of these examples for time but here's an example of a patient who called into the office because she had some questions about side effects and I had a cancellation on my schedule so I decided I'm just going to call her I'm not going to have the staff schedule her for a visit with me and this is where I might use the telephone e m services and these again are given in time segments and these are codes 99441-99443 and so the key pieces here are this is unscheduled so this is just for my callbacks to patients in my own administrative time and again the patient must have initiated request and it can't be related to a visit that I just had in the prior seven days or lead to just recommending an office visit so some of you had asked about the final rules for coverage we're going to find out more about 2024 later what I can tell you is that in 2023 these codes have been extended to the end of the calendar year um key points for you just documenting the basics of your service your soap note your assessment and plan and that your patient can send it to the visit and then I'll put the rest of this information in the information given to you with the slides after the presentation we don't want to double up on services so if we're having a staff member call back that patient we don't want the physician to bill for that as well so the biggest thoughts for us as Physicians is we want to provide non-face-to-face care we don't want to lock our patients into visits with us and these are ways to use our administrative time to get back to patients right away and we can use these incongruity with the other codes that you just heard about so I'll stop from there I'm going to stop screen sharing I'm sorry I went a little bit fast in our last few minutes and we can answer a couple of questions and otherwise we will put out all these answers to you in an email any questions thank you so much Dr Ashman we're going to look through the pre-submitted questions that we didn't have time to get to and like Dr ashma said we'll make sure that if any of the ones that you submitted while registering for the meeting weren't answered that we send you one via email so we will get those ones answered that we didn't get to today as well excellent we don't want to keep you over time these are absolutely fabulous questions and we will get them back to you thank you all right thank you all so much um we're gonna get the slides out to you including the information to claim CME later this afternoon so thanks to everyone we really appreciate your time thank you so much bye-bye bye