DorlandHealth

We pose a series of questions to Kathy Craig, MS, RN, CCM, president of Craig Research Continuum, to learn about the growing set of tools surrounding caseload issues, including the latest on acuity methodology. Ms. Craig, who serves on NCMN (Canada) Board, PCM Editorial Board, and CMSA’s Caseload Work Group, can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Q: As someone involved on the frontlines of tackling the caseload quandary, what are the most important issues that need to be addressed and steps that need to be taken?

A: What frontline case managers ask me to solve is bringing equity to case management caseloads quickly, fairly and dependably. Supervisors and business leaders ask for a method that is objective, reportable as data, and reproducible in a way that confirms validity.

In this edition of Ask the Expert, we consult with Rosalind Joffe, the founder and president of cicoach.com, a career coaching firm dedicated to helping professionals with chronic illness, to inquire about chronic illness, return to work, and the role of professional advocates. Ms. Joffe can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Q: I am a case manager who works with patients with chronic disease. More times that not, my patients want to work, but the employer is leery about bringing them back after a prolonged time out of work. As a career coach for patients with chronic conditions, what advice would you provide to the patient as well as to the employer?

A: This question highlights a critical challenge many workers with chronic illness face when returning to work. An employer’s reluctance regarding an employee’s return to work after a prolonged absence can set the stage for failure.

That is why it is helpful if a case manager “steps into a manager’s shoes” to understand why this might happen. With this knowledge, you are better prepared to help your patients address these concerns successfully.

In this edition of Ask the Expert, Teri Treiger, RN-C, MA, CCM, CCP, CPUR, a Clinical Product Manager at McKesson Health Solutions and forthcoming President-Elect of CMSA, discusses the importance of Current Procedural Terminology codes as they relate to the practice of case management.

Current Procedural Terminology (CPT®) is a code set maintained and annually updated by the American Medical Association (AMA). Each code is five digits in length and describes a medical, surgical, or diagnostic service delivered by a health care provider. Created in 1966, CPT codes provide a common framework for communication and reporting purposes. This code set was designated as the national standard for use by physician and health care professional services by the Department of Health and Human Services in 2000. With a few exceptions, in the fall of each year, the AMA issues a revision of the code set. The changes become effective as of the following January.

Q: Why should CPT codes matter to case managers?

A: Presently, there is no specific code(s) dedicated for use by case management professionals, the lack of which carries ramifications. Perhaps the most important goes to the ability to prove the value of case management within the health care system. Because there is no consistent, accumulated data regarding case management activity or cost, uniform analysis and reporting is extremely challenging. Another impact is that case management professionals do not have a dedicated CPT code with which to submit claims to third-party payers for services rendered.

Q: Do CPT codes exist that pertain to case management that could be used?