Primary care practitioners are probably the first contact for many patients for medical requirements, health maintenance, and counseling. Other medical services provided by primary care practitioner includes disease prevention, treatment for chronic illnesses, scans and tests, routine examinations, obstetrics and prenatal care, basic medical aid for injuries, and providing referrals to specialists such as neurologists, etc.
The CMS has been trying to increase payments for primary care physicians via coding. CMS has over the years added services with high relative value units for wellness visits and transitional care management, including payments for chronic care management. The Patient Protection and Affordable Care Act was founded on the principle that primary care services would fulfill and improve the basic health of America’s public while trying to maintain the cost which is already 19.5% of the GNP (by 2017). Hence came into play added features such as increased interest and enhanced payments for primary care providers; with insurance coverage for kids under 26, funded examinations, and subsidized insurance pools.
CMS added codes for two key purposes:
- Care management support for patients receiving behavioral health treatment
- Regular psychiatric inter-specialty consultation to the primary care team, particularly regarding patients whose conditions are not improving
Three Codes for Psychiatric Collaborative Care Management:
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP.
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.
Initial or subsequent psychiatric CoCM, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultations with a psychiatric consultant and directed by the treating physician or other qualified health care professional.
All these require that three professionals are involved: primary care physician, psychiatrist, and a behavioral care manager (his/her time is counted), services are billed by the primary care physician once every month.
New Code for Care Management for Behavioral Health Conditions:
at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month. Here time is counted by clinical staff time.
All of the preceding codes with additional requirements can be referred to here:
– HCPCS code G0505 is being recognized for the cognitive evaluation of a patient with dementia or Alzheimer’s disease.
– HCPCS code G0506 may be used once at the initiation of CCM.
– CMS is recognizing CPT service such as non-face-to-face prolonged services codes 99358 and 99359 followed by 99358 is for the first hour of this work and, following CPT rules, maybe billed after 31 minutes.
– It is also beneficial to know when to use modifier 25 and 59.
The year 2017 bought in new revenue generation opportunities for primary care services which included non-face-to-face prolonged services and four new HCPCS codes were introduced for primary care practitioners looking after behavioral health. Boosting of revenues in primary care can be readily attributed to following strategies such as: creating a user friendly website which can further encourage feedback for others to evaluate, social media platforms to be used for referrals and reviews, make use of telemedicine for virtual patients, avoid overpaying or overstocking, eliminate paperwork by making use of technology such as EHRs and cloud services wherein the patient can have access to all his reports anytime, evaluate and regulate the patient mix, online charts and availability of scheduling online appointments, and checking for test results, offering new services (developmental pediatric screening, injections for joints, audiometry, simple fracture care, and interpretation of pulmonary function test) can greatly enhance the practice’s revenues.