Last week the American Medical Association made a formal request to the Centers for Medicare and Medicaid Services, recommending that the federal insurance body implement new and revised medical codes for a number of care coordination services that are commonly bundled, including telephonic outreach, patient education and medication management.
At the heart of the AMA’s recommendations is the treatment of patients with chronic disease, and the manner in which team-based care is reimbursed through the federal coding structure. The therapeutic areas, along with the care coordination services offered in each one, include:
- Anticoagulant management. The AMA recommends the adoption of two codes for anticoagulation management (99363 and 99364), which include coordinated services. “These services are also cost effective, eliminating unnecessary face-to-face physician services which are required as a substitute to a more common sense strategy to pay for the management of these patients,” says the AMA.
- Education and training for patient self-management. A set of three codes, this category would standardize “education and training for patient self-management by a qualified, non-physician health care professional” such as an RN, case manager or other team member. Per the AMA: “Immediate implementation of the education and training services…is recommended to recognize the costs associated with team based care.”
- Medical team conference. This category of three codes would impact reimbursement for the coordinated care provided by emerging models like the medical home. The recommendation calls for the allowance of separate reporting when patients are not present in a medical team meeting.
- Telephone services. The AMA recommends a distinct separation in the reimbursement available for telephone services, which can vary in nature, scope and length.
This week Dr. Barbara Levy, chair of the AMA’s Relative Value Scale Update Committee (RUC), released a statement reiterating the recommendations contained within the letter to Dr. Donald Berwick, CMS administrator.
“When treating patients with chronic conditions, such as heart disease and diabetes, physicians provide many services that are currently not recognized or compensated by Medicare,” said Dr. Levy in the statement. “[The RUC is] recommending the recognition of these critical services, which include telephone calls, patient education and the management of anticoagulant medication to prevent strokes. By accepting this recommendation, CMS can take a critical first step by January 1 to recognize these important services provided by physicians who care for chronically ill patients.”
All recommendations stem from the work of the Care Coordination Workgroup
, a combined group of physicians brought together from the aforementioned RUC and the CPT Editorial Panel. The Care Coordination Workgroup, which seeks to address “the adequacy of coding and valuation of care coordination services and management of chronic disease,” according to the AMA website, also offered recommendations addressing the medical home model, high-cost medical supplies, and other clinical areas like cardiovascular treatment, psychoanalysis and molecular pathology.
The AMA hopes to see its recommendations included within the revised CPT code structure to be released January 1, 2012.
The letter sent to Dr. Berwick is available here [PDF]
Ed. Note: The Care Coordination Summit, exploring cutting-edge trends and delivery models impacting the care coordination team, is taking place October 21, 2011, in Washington, D.C. See the full schedule here.