Code Who can Payers PDCM Notes Documentation provide service? G9007: Primary BCBSM All Payers Y Description: Scheduled meetings between Primary Care Coordinated Care Commercial, Description: Scheduled meetings between Practitioner and care manager to discuss a patient’s care care fee, Practitioner BCBSM PCP and care manager to discuss a patient’s plan (without the patient present). Can be conducted face- scheduled Medicare care plan (without the patient present). Can by telephone or by secured video conference. team be conducted face-to-face, by telephone or by Advantage, conference MA secured video conference. Priority Documentation: Lead Care Health Date of Team Meeting Manager and Conditions of Payment: Other Care Duration of discussion for individual Patient To be billed by the primary care Team practitioner and payable only to the Name and credentials of allied professionals present Members primary care practitioner. for Team Conference Based on a change in the patient’s care plan Nature of the discussion and pertinent details Priority Discussions must be focused on the Any revisions to the Care Plan Goals, Outcomes, Health patient’s individualized care plan Interventions, and Target Dates. Outcomes and next Physician (including significant change in patient steps for each patient must be agreed upon and status and/or unresolved barriers) and documented. goal achievement Outcomes and next steps for each Priority Health- Include documentation fields listed above in patient must be agreed upon and "all payer" section, plus the following: documented Diagnoses discussed Documentation can be completed Treatment Plan, Self-Management Education, by the physician or the care Medication Therapy, Risk Factors, Unmet Care, Physical manager Status, Emotional Status, Community Resources, Readiness to Change. Tip: self- management goals. Claims Reporting Requirements: Bill Physician coordination activities and approval of Care separately for each patient discussed Plan Billed under the physician and is payable only to the Quantity Limits: Limit of one G9007 paid per physician primary care practitioner, per practice, per Physician approval of care plan patient, per day. This limit does not apply across specialty types; for example, when a patient is being managed by both a PCP care manager and an oncology care manager, both care managers may conduct a team conference as needed and
Code Who can provide service? Payers PDCM Notes Documentation G9007: Coordinated care fee, scheduled team conference Primary Care Practitioner MA Lead Care Manager and Other Care Team Members Priority Health Physician BCBSM Commercial, BCBSM Medicare Advantage, Priority Health Y All Payers Description: Scheduled meetings between PCP and care manager to discuss a patient’s care plan (without the patient present). Can be conducted face-to-face, by telephone or by secured video conference. Conditions of Payment: To be billed by the primary care practitioner and payable only to the primary care practitioner. Based on a change in the patient’s care plan Discussions must be focused on the patient’s individualized care plan (including significant change in patient status and/or unresolved barriers) and goal achievement Outcomes and next steps for each patient must be agreed upon and documented Documentation can be completed by the physician or the care manager Claims Reporting Requirements: Bill separately for each patient discussed Quantity Limits: Limit of one G9007 paid per primary care practitioner, per practice, per patient, per day. This limit does not apply across specialty types; for example, when a patient is being managed by both a PCP care manager and an oncology care manager, both care managers may conduct a team conference as needed and Description: Scheduled meetings between Primary Care Practitioner and care manager to discuss a patient’s care plan (without the patient present). Can be conducted by telephone or by secured video conference. Documentation: Date of Team Meeting Duration of discussion for individual Patient Name and credentials of allied professionals present for Team Conference Nature of the discussion and pertinent details Any revisions to the Care Plan Goals, Outcomes, Interventions, and Target Dates. Outcomes and next steps for each patient must be agreed upon and documented. Priority Health- Include documentation fields listed above in "all payer" section, plus the following: Diagnoses discussed Treatment Plan, Self-Management Education, Medication Therapy, Risk Factors, Unmet Care, Physical Status, Emotional Status, Community Resources, Readiness to Change. Tip: self- management goals. Physician coordination activities and approval of Care Plan Billed under the physician and is payable only to the physician Physician approval of care plan face-
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx