Managing patients with multiple chronic illnesses is a key component of value-based care programs. It requires continuous, coordinated efforts that extend beyond traditional office hours and visits.
The reason? Patients with several chronic conditions (e.g., diabetes, hypertension, arthritis, cancer, etc.) are at significant risk of death, acute exacerbation, decompensation, or functional decline.
Thus, these patients require dedicated clinical staff time to ensure uninterrupted communication and disease management across different disciplines. That’s where CPT code 99439 comes into play!
This comprehensive guide covers everything you need to know to accurately bill these services.
So without further ado, let’s get started!
CPT Code 99439 – Description
CPT code 99439 covers each additional 20 minutes of physician-directed clinical staff time spent on supporting and coordinating a patient’s care across multiple disciplines.
Since it is from the ‘Chronic Care Management (CCM) Services’ code range, you can only use this code while managing conditions for the qualifying patients. Simply put, the patient must have two or more chronic conditions, placing the patient at significant risk of functional decline, acute exacerbation, and death.
For context, 42% of individuals have two or more, and 12% have at least five chronic diseases in the U.S. alone. Moreover, five of the nation’s top ten leading causes of death are associated with these chronic illnesses.
Note that CPT 99439 is an add-on code. That is, you cannot report it without its primary code, CPT 99490, which covers the initial 20 minutes of physician-directed clinical staff time per calendar month.
Scenarios Where CPT Code 99439 is Applicable
Now that we understand what CPT code 99439 covers, it is time to review a few real-world clinical scenarios. These will help you gain a better understanding of its application:
Post-Hospital Discharge with Complex Medication Regimen
Before we start discussing this scenario, let’s take a look at some troubling stats!
Currently, the global prevalence of congestive heart failure (CHF) is 64.34 million cases. On average, 35.5 million people in the U.S. alone have chronic kidney disease (CKD). Moreover, approximately 38 million people in the U.S. have diabetes, while 90-95% of these individuals have type 2 diabetes.
With that said, picture an 80-year-old male patient recently discharged from the hospital after an acute exacerbation of CHF. He has more than two chronic illnesses, including CHF, CKD, and type 2 diabetes.
As a result, the clinical staff spent additional time (provider-directed) this month on coordination activities.
For instance, the staff scheduled multiple follow-up appointments across different specialties, including endocrinology, nephrology, and cardiology. Moreover, they helped in reconciling the new medication list with existing prescriptions. They also arranged home health visits and educated caregivers on medication administration and potential red-flag symptoms.
Here, CPT code 99439 applies for each additional 20 minutes spent on these activities.
New Cancer Diagnosis Overlaying Existing Conditions
Assume a 67-year-old female with well-controlled dyslipidemia and hypertension has been diagnosed with metastatic lung cancer.
As a result, the provider-directed clinical staff spent additional time coordinating rapid referrals to oncology and radiation therapy. They also explained treatment options and potential side effects.
It involves assisting the patient in navigating insurance authorization for new therapies. Moreover, they discussed palliative care options while ensuring current chronic conditions remain stable.
You can report CPT code 99439 to bill for each additional 20 minutes of physician-directed clinical staff time per calendar month.
Frequent Symptom Exacerbations and Caregiver Support
Do you know that by the time Parkinson’s disease (PD) is diagnosed, most patients lose approximately 60-80% of their dopamine-producing cells in the substantia nigra. For the unversed, dopamine is an integral neurotransmitter. Its loss can lead to significant disruption in the brain’s ability to control movement.
Now, imagine a 72-year-old male patient with chronic pain due to severe osteoarthritis, advanced PD, and recurrent urinary tract infections (UTIs).
Recently, he has started experiencing a rapid functional decline. Thus, the clinical staff (physician-directed) spent extra time this month coordinating with urologists, neurologists, and pain management specialists.
Moreover, they educated the patient’s adult children on crisis management and symptom recognition. Besides, they assisted in arranging for respite care services to support the overwhelmed caregivers.
Therefore, CPT code 99439 will be reported to bill for an additional 20 minutes of clinical staff time after the initial 20-minute session.
CPT Code 99439 – Billing & Reimbursement Guidelines
The following are the key billing and reimbursement guidelines for CPT code 99439:
Meet the Documentation Requirements
Just like any other procedure, CPT code 99439 also has some prerequisites. Meeting these ensures timely reimbursement for the additional clinical staff time spent on providing support and coordination across disciplines.
One essential requirement is detailed documentation. It also helps you demonstrate the medical necessity of the billed service. Here’s what your documentation should include:
- Initial patient consent (written or verbal) for CCM services.
- Comprehensive care plan for maintaining and controlling patient symptoms.
- Precise tracking and documentation of the clinical staff’s time spent supporting and coordinating care.
- Carefully linking all performed activities to the established care plan and the patient’s chronic conditions to support medical necessity.
Understand the CPT Code 99439 Service Components
Note that CPT code 99439 covers non-face-to-face provider-directed administrative activities critical for ensuring high-quality care coordination. These may include any or all of the following:
- Monitoring or revision of patient-centered care plans.
- Coordination of care across different specialties and physicians.
- Patient and/or caregiver education.
- Communication with pharmacies.
- Medication reconciliation and management.
- Updating medical records in the EHR system.
- Around-the-clock patient access to clinical staff.
Be Wary of Unit Limits and Time Requirements
You must always bill CPT code 99439 in conjunction with CPT 99490 in 20-minute increments. However, there is a unit limit associated with it. That is, you can only bill it twice per patient per calendar month.
Simply put, you are allowed to bill up to 60 minutes of reimbursable CCM services, i.e., 20 minutes with 99490 and 40 minutes with two units of 99439.
Know Who Can Bill For CPT Code 99439
Typically, the following healthcare providers can report CPT code 99439:
- Certified Nurse Midwives (CNMs)
- Clinical Nurse Specialists (CNSs)
- Physician Assistants (PAs)
- Nurse Practitioners (NPs)
- Physicians (MDs)
Let’s reiterate! The clinical staff performs administrative tasks under the supervision of the billing provider. It means the physician oversees the service but is not physically involved.
Summary
Phew! That was a lot of detail to follow through. Let’s make it a little easier to remember by summarizing the key takeaways.
First, we explained CPT code 99439’s descriptor. It covers an additional 20 minutes of non-face-to-face provider-directed clinical staff time spent on supporting and coordinating care across multiple disciplines.
Next, we shared some real-world clinical scenarios. These include frequent symptom exacerbations and caregiver support, new cancer diagnosis overlaying existing conditions, and post-hospital discharge with a complex medication regimen.
Finally, we discussed the essential billing and reimbursement guidelines related to CPT code 99439.
Hopefully, these details will equip you with the knowledge to streamline your CCM billing. However, if you struggle and require professional assistance, feel free to outsource CCM billing services to MediBillMD.
