PRACTICE New Principal Care Management Service Codes Available January 1, 2022 While the next phase of significant revisions to the E/M code set is not slated for another year, a new set of principal care management (PCM) CPT codes will bring opportunities for neurologists and neurology APPs to report their time spent managing the care of a patient with a single high-risk disease. The PCM codes differ from existing care management services which require the management of multiple high-risk conditions or diseases. The AAN is pleased with the addition of the new codes as our members often treat patient with a single condition that requires significant care management activities. Effective January 1, 2022, four new codes will be available: two for reporting physician time and two for reporting clinical staff time: 99424: used to report the first 30 minutes provided personally by a physician or qualified health care professional (QHP), per calendar month +99425: used to report each additional 30 minutes provided personally by a physician or other QHP, per calendar month 99426: used to report the first 30 minutes of clinical staff time directed by physician or other QHP, per calendar month +99427: used to report each additional 30 minutes of clinical staff time directed by a physician or other QHP, per calendar month As is the case with existing chronic care management services, PCM services can only be reported when certain required elements are met: One complex chronic condition expected to last at least three months, and that places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death
The condition requires development, monitoring, or revision of a disease-specific care plan The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities Ongoing communication and care coordination between relevant practitioners furnishing care
Coding tips to keep in mind when determining if the new codes are appropriate for your practice include: PCM services are reported for total time per calendar month. 99424 and 99426 are reported only once per calendar month. PCM services less than 30 minutes in a calendar month are not reported separately. 99424–99427 may be reported by different physicians or qualified health care professionals in the same calendar month for the same patient. Documentation should reflect coordination among relevant managing clinicians. Visit AAN.com/EM for additional E/M coding resources.
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AANnews • January 2022
