Requirements For Reporting PCM In 2022
The Principal Care Management (PCM) provider was created by the Centers for Medicare and Medicaid Services (CMS) in 2020. The goal of this system became to permit the provision of extra care to patients with a single chronic situation. In 2022, there are 4 new codes to invoice PCM offerings that update current codes for those offerings.
When introducing PCM offerings, CMS predicted that experts who’re centered on coping with patients with a single complicated chronic situation requiring sizeable care control will invoice PCM offerings the most. Outsourcing scientific billing is a great choice to meet the necessities for billing PCM codes.
Principal Care Management Services: Key Points
CMS defines a regular patient (for PCM) as one that “might also additionally present to their number one care practitioner with an exacerbation of a current chronic situation.”
With the PCM codes, practices can invoice for care control for offerings provided to patients with one critical chronic situation with the aid of using an expert or number one care doctor. While Chronic Care Management Services (CCM) focus on the care of or greater chronic situations, PCM describes care control offerings for a single, complicated chronic situation. The key factors for the supply of PCM offerings are as follows:
- A qualifying situation for PCM offerings can be predicted to be ultimate among 3 months to 365 days or till the death of the patient.
- The qualifying situation has to be of such complexity that it can’t be controlled efficaciously with the aid of using number one care and requires control by another, greater specialized practitioner. Typically, a PCM service is initiated to cope with an exacerbation of the affected person’s chronic situation or current hospitalization. While an expert might also additionally manage services for the particular chronic situation, the patient’s number one care doctor will preserve to oversee the patient’s overall care.
- A patient can obtain PCM services from more than one expert for more than one distinctive situation concurrently, e.g., a heart specialist for arrhythmia and a pulmonologist for chronic obstructive pulmonary disorder (COPD).
New PCM Codes For 2022 In 2022, 4 New PCM Codes Update The 2 Preceding PCM Codes (HCPCS Codes G2064 And G2065):
CPT code 99424:
PCM offerings for a single high-risk disorder first half-hour supplied individually with the aid of using a doctor or different certified fitness care professional, consistent with calendar month.
CPT code 99425:
PCM offerings for a single high-risk disorder every extra half-hour supplied individually by a doctor or different certified fitness care professional, consistent with calendar month.
CPT code 99426:
PCM, for a single high-risk disorder first half-hour of medical group of worker time directed by a doctor or different certified fitness care professional, per calendar month.
CPT code 99427:
PCM offerings, for a single high-risk disease every extra half-hour of medical group of worker time directed by a doctor or different certified fitness care professional, consistent with the calendar month.
Requirements For Billing PCM Services
CMS has set forth numerous necessities that should be met for billing PCM codes for offerings supplied to an affected person. Important situations include: The billing practitioner should be a doctor or a certified fitness care practitioner. PCM offerings have to now no longer be pronounced by the equal practitioner simultaneously with different care control services. According to the Final Rule, the predicted final results of the supply of PCM offerings is for the patient’s situation to be stabilized by the treating expert so that average care may be back to the patient’s number one care practitioner.
The billing practitioner has to file ongoing communication and care coordination among all practitioners presenting care to the affected person. For new patients and patients not seen within 12 months before initiation of PCM, the billing practitioner should behavior a starting up to go with the patient to teach the patient about PCM and obtain the patient’s knowledgeable consent.
This go-to may be an annual health visit (AWV) or a different one-by-one billable go-to. Consent – The patient’s informed consent may be acquired verbally or in writing and have to be documented withinside the patient’s scientific record. PCM offerings are aimed at enhancing patient fitness outcomes, however now no longer reporting PCM services effectively can go away revenue at the table.
Outsourced scientific billing and coding offerings can assist number one care physicians and experts treating high-risk sicknesses or complicated chronic situations to get properly reimbursed for the offerings they provide.