Code Who can Payers PDCM Notes Documentation provide BCBSM service? G9002: BCBSM BCBSM All payers Y Description: Individual face-to-face care management Individual Lead Care Individual face-to-face intervention visits Description: Manager Documentation: care management intervention visits Visit and Other Medicare Conditions of payment: Name/credentials of team member performing the service Care Team Advantage, Only conducted/billed when patient Date of Service Priority Members circumstances and/or the nature of Duration of Face-to-Face Visit Health the service require person-to- All Diagnoses pertinent to encounter Priority person interaction to be successful. Medication reconciliation Health May include the patient’s Focused discussion pertinent to the patients Care Plan QHP caregiver/family (BCBSM) - progress, changes Must include focused discussion of Short-Term Goal, including target date patient’s care plan Long-Term Goal, including target date Can also include treatment plan, Time Frame for Follow Up self-management education, Name of Individual(s) in Attendance, Relationship to medication therapy, risk factors, Patient care, physical status, Nature of the Discussion and Pertinent Details emotional status, community Updated Status on Patient’s Medical Condition, care needs and resources, readiness to change and progress to goal ongoing care plan development Care Needs and progress to goal(s) Any revisions to the Care Plan Interventions, and Target MA Dates Code may be billed one time per day. If Patient/Care Giver’s Level of Understanding multiple members of the care team Readiness for Change provide this service on the same date, to Priority Health- include documentation fields listed in the same patient, this procedure code "all payer" section plus the following: can be quantity billed. For example: 1-45 Diagnosis Discussed, Treatment Plan, Self-Management minutes (1), 46-75 Education, Risk Factors, Unmet Care, Emotional Status, minutes (2), 76-105 minutes (3), or Community Resources 106-135 minutes (4). Name of Patient’s PCP Priority Health Physician coordination activities and approval of Care Plan Code may be billed one time per day. Patients agreement with care plan
Code Who can provide service? Payers PDCM BCBSM Notes Documentation G9002: Individual Visit BCBSM Lead Care Manager and Other Care Team Members Priority Health QHP BCBSM Medicare Advantage, Priority Health Y All payers Description: Individual face-to-face care management intervention visits Conditions of payment: Only conducted/billed when patient circumstances and/or the nature of the service require person-to- person interaction to be successful. May include the patient’s caregiver/family Must include focused discussion of patient’s care plan Can also include treatment plan, self-management education, medication therapy, risk factors, care, physical status, emotional status, community resources, readiness to change and ongoing care plan development MA Code may be billed one time per day. If multiple members of the care team provide this service on the same date, to the same patient, this procedure code can be quantity billed. For example: 1-45 minutes (1), 46-75 minutes (2), 76-105 minutes (3), or 106-135 minutes (4). Priority Health Code may be billed one time per day. Description: Individual face-to-face care management intervention visits Documentation: Name/credentials of team member performing the service Date of Service Duration of Face-to-Face Visit All Diagnoses pertinent to encounter Medication reconciliation Focused discussion pertinent to the patients Care Plan (BCBSM) - progress, changes Short-Term Goal, including target date Long-Term Goal, including target date Time Frame for Follow Up Name of Individual(s) in Attendance, Relationship to Patient Nature of the Discussion and Pertinent Details Updated Status on Patient’s Medical Condition, care needs and progress to goal Care Needs and progress to goal(s) Any revisions to the Care Plan Interventions, and Target Dates Patient/Care Giver’s Level of Understanding Readiness for Change Priority Health- include documentation fields listed in "all payer" section plus the following: Diagnosis Discussed, Treatment Plan, Self-Management Education, Risk Factors, Unmet Care, Emotional Status, Community Resources Name of Patient’s PCP Physician coordination activities and approval of Care Plan Patients agreement with care plan
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx