The first of January, Medicare will be releasing two new CPT codes to support care management of patients with a single chronic condition. Primary Care Management (PCM) requires a clinical staff member or provider to dedicate at least 30 minutes of "Non-face-to-face" time to a particular patient in order to bill for code G2065 or G2064. In ThoroughCare, PCM will directly integrate into the already existing CCM program. If you wish to activate the PCM program on your individual ThoroughCare site, let us know!
On Average, the reimbursement for 30 minutes of "non-face-to-face" clinical staff time spent managing a patient's care is $42.00 (CPT: G2065). If the time spent is managed by a provider this reimbursement average jumps up to $74.24 (CPT: G2064).
How to Manage a PCM Patient:
If you wish to have the PCM program enabled for your site, you must also have the new UI enabled. This program has only been integrated into the new UI and we suggest using it if you have patients within the program. Once the new UI is enabled by one of our team members go ahead and click the "Try New Theme" button located in the upper right hand corner of the dashboard, worklist, or patient view page.
Once the new Theme/UI is visible, search the patient's name you wish to enroll in the PCM program.
Now, navigate to the patient view page by clicking the the patient's name, EHR ID, or "View Button".
If your patient is not currently enrolled in CCM, enroll them now. PCM is run under the CCM program so patients must give proper consent. If you wish to know how to enroll a patient click here. If your patient is already enrolled continue through steps.
Once on the patient's view page, navigate to the "Conditions" tab.
From here, click " + Add Condition ".
In order for a patient to be eligible for the PCM program they must have a single chronic condition listed. Once two conditions are listed they no longer qualify for PCM and instead qualify for CCM. When the " + Add condition " button is clicked a drop-down bar will appear for you to select a condition. Click to select.
Make sure to specify the program as CCM and add the correct diagnosis code for the condition stated.
Before saving take a second to notice the orange banner at the top of the tab. This is a note to warn you that only one chronic condition is chosen, so the patient will be managed under PCM guidelines not CCM. Once finished click "Save".
Now to be billable for PCM, a care manager or physician must dedicate 30 minutes of "non-face-to-face" time towards the patient's care within the calendar month. Because PCM is an extension of CCM, all PCM notes and time logging should be documented on the patient's CCM page. To log time Navigate to the patient's CCM page located under "Manage CCM" on the "CCM" tab.
From here you will complete your time logging for the patient (must be 30 minutes to create a claim). Click "Log Time" when the log is completely filled out.
Note: If a physician performs the task that time is being logged for make sure to chose the physicians name when filling out the "Performed by" field. This is crucial when creating a claim.
Once a Care Manager reaches 30 minutes of PCM time, navigate to the "Billing" tab located on the patient view page. From here a user can see the PCM claim under the filter "Ready to bill".
If a provider completed the time logging then the claim shown will include the CPT code "G2064" as shown below.
Note: For any questions, or problems, unanswered by this article click the chat window in the bottom right hand corner of any ThoroughCare page to be assisted by a member of our team.