Primary Care Codes for Payment (1)

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Primary Care Codes for Payment
The technique by which Current Procedural
Terminology (CPT) codes are developed so that
physicians can get paid for their services and
procedures is highly entangled and deserves some
explanation. Furthermore, Medical Billers and
Coders (MBC) is effectively occupied with this
procedure and advocates for the eventual benefits
of its clients, which incorporates improved
payment for primary care codes and subspecialists
under Medicare. Primary Care Codes for Improved
Payment CPT codes report medical services and
procedures physicians and other health care
experts perform. During that time, the CPT
Editorial Panel meets to audit new and existing
CPT codes for approval or updating. The Relative
Value Update Committee (RUC) assigns values to
new CPT codes and re-examines existing codes.
This advisory body recommends the value of
physician services to the Centers for Medicare
and Medicaid Services (CMS). Physician payments
are then made for each visit or on a
per-procedure basis, as the CPT codes
characterize. Most private payers adopt the
values for services from CMS yet may apply
diverse transformation factors.
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Primary Care Codes for Payment

• Below is the List of Codes (ref ACPs Coding )
  that Physicians can use
• 99421 Online digital evaluation and management
  service for an established patient for up to 7
  days, the cumulative time during the 7 days 510
  minutes
• 99422 Online digital evaluation and management
  service for an established patient for up to 7
  days cumulative time during the 7 days 11 20
  minutes
• 99423 Online digital evaluation and management
  service for an established patient for up to 7
  days, the cumulative time during the 7 days 21
  or more minutes
• Digitally Stored Data Services/Remote Physiologic
  Monitoring
• The two new codes99473 and 99474support home
  blood pressure monitoring, which provides
  valuable information physicians can use to
  diagnose and manage hypertension better. Home BP
  monitoring also helps patients actively
  participate in the process.
• 99473 Self-measured blood pressure using a
  device validated for clinical accuracy patient
  education/training and device calibration
• 99474 separate self-measurements of two readings
  one minute apart, twice daily over 30 days
  (minimum of

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Primary Care Codes for Payment

• 12 readings), collection of data reported by the
  patient and caregiver to the physician or other
  qualified health care professional, with the
  report of average systolic and diastolic
  pressures and subsequent communication of a
  treatment plan to the patient.
• Remote Physiologic Monitoring Treatment
  Management Services
• 99457 Remote physiologic monitoring treatment
  management services, clinical staff/physician/othe
  r qualified health care professional time in a
  calendar month requiring interactive
  communication with the patient/caregiver during
  the month first 20 minutes
• 99458 each additional 20 minutes (List
  separately and code for primary procedure).
• Chronic Care Management and Complex Chronic Care
  Management
• G2064 Comprehensive care management services for
  a single high-risk disease, e.g., Principal Care
  Management, at least 30 minutes of physician or
  other qualified health care professional  time
  per calendar month with the following elements
  One complex chronic condition lasting  at least 3
  months
• G2065 Comprehensive care management for a single
  high-risk disease service, e.g., Principal Care
  Management, at least 30 minutes of clinical staff
  time directed by a physician or other qualified
  health care

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Primary Care Codes for Payment

• professional per calendar month with the
  following elements one complex chronic condition
  lasting at least 3 months
• 99490 Chronic care management services, at least
  20 minutes of clinical staff time directed by a
  physician or other qualified health care
  professional, per calendar month
• G2058 Chronic care management services, each
  additional 20 minutes of clinical staff time
  directed by a physician or other qualified health
  care professional, per calendar month
• 99487 Complex chronic care management services,
  with the following required elements multiple
  (two or more) chronic conditions expected to last
  at least 12 months, or until the death of the
  patient, chronic conditions place the patient at
  significant risk of death, acute exacerbation/
  decompensation, or functional decline,
  establishment or substantial revision of a
  comprehensive care plan, moderate or high
  complexity medical decision making 60 minutes of
  clinical staff time directed by a physician or
  other qualified health care professional, per
  calendar month
• 99489 Each additional 30 minutes of clinical
  staff time is directed by a physician or other
  qualified health care professional, and complex
  chronic care management services are provided per
  calendar month.
• Advanced Primary Care Planning

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Primary Care Codes for Payment

• 99497 Advance care planning including the
  explanation and discussion of advance directives
  such as standard forms (with completion of such
  forms, when performed), by the physician or other
  qualified health care professional first 30
  minutes, face-to-face with the patient, family
  member(s), and surrogate
• 99498 Advance care planning each additional 30
  minutes.
• Behavioral Health Management
• 99484 Care management services for behavioral
  health conditions, at least 20 minutes of
  clinical staff time, directed by a physician or
  other qualified health care professional time,
  per calendar month.
• Psychiatric Collaborative Care Model
• 99492 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 qualified health care
  professional
• 99493 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

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Primary Care Codes for Payment

• 99494 Initial or subsequent psychiatric
  collaborative care management, each additional 30
  minutes in a calendar 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.
• Effective Primary Care Codes for Payment
  management are crucial in addressing legacy AR
  (accounts receivable) challenges. Legacy AR
  refers to aged, unpaid claims that have
  accumulated over time, often due to coding
  errors, claim denials, or delays in payment
  processing. By ensuring accurate use of primary
  care codes, including evaluation and management
  (E/M) codes and preventive care codes, healthcare
  providers can significantly reduce the backlog of
  unresolved claims. Streamlining coding practices
  improves the accuracy of claims submissions and
  accelerates the payment cycle, mitigating legacy
  ARs impact and enhancing primary care practices
  financial stability.
• Get More Help
• Are you stuck on medical billing? Know what
  challenges in Credentialing, Charge Entry,
  Payment Posting, Benefits/Eligibility
  Verification, Prior Authorization, Filing claims,
  AR Follow-Ups, Old AR, Claim Denials, and
  resubmitting rejections with Medical Billing
  Companies  Medical Billers and Coders,
  especially when it comes to Primary Care Billing.

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Primary Care Codes for Payment

• If your revenue cycle management
  processes hinder your ability to provide these
  services, contact us at MBC to learn how we can
  help. Our experienced teams can alleviate medical
  coding,  and billing concerns so you can focus
  more on patients.
• FAQs
• What are Primary Care Codes?
• Primary Care Codes are specific medical billing
  codes used to document and bill for services
  provided by primary care physicians. These codes
  include evaluation and management (E/M) codes,
  preventive care codes, and various procedure
  codes, ensuring that healthcare providers are
  accurately compensated for their services.
• Why are Primary Care Codes necessary for payment?
• Primary Care Codes are crucial for payment
  because they standardize the billing process,
  making it easier for insurance companies to
  understand and process claims. Accurate coding
  helps avoid claim denials, ensures proper
  reimbursement, and reduces the chances of revenue
  loss due to coding errors or omissions.

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Primary Care Codes for Payment

• How can primary care codes help reduce legacy AR?
• Primary Care Codes can significantly reduce
  legacy AR by ensuring that claims are correctly
  coded submitted on time. Accurate coding
  reduces the likelihood of claim denials and
  delays, facilitating faster payment and
  minimizing the accumulation of unpaid allegations
  that can negatively impact a practices financial
  health.
• What common challenges do providers face with
  Primary Care Codes?
• Common challenges include staying updated with
  code changes, ensuring accurate documentation,
  avoiding upcoding or under coding, and managing
  complex coding scenarios for patients with
  multiple conditions. If not managed effectively,
  these challenges can lead to claim denials,
  delayed payments, and increased administrative
  burdens.
• How can healthcare providers stay compliant with
  Primary Care Codes?
• Healthcare providers can stay compliant by
  regularly training their staff on the latest
  coding guidelines, utilizing coding software and
  resources, conducting periodic audits to ensure
  accuracy, and staying informed about changes in
  coding regulations. Partnering with a specialized
  medical billing company can help manage
  compliance and streamline the billing process.