Geriatric Care

Geriatric care management is the process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible.

  • For example, they may assist families of older adults and others with chronic needs such as those suffering from Alzheimer’s diseaseor other dementia.

Geriatric Care Medical Necessity- Conditions / ICD ‘S:

Geriatric care management is medically necessary if the patient is elderly old and suffering from the following conditions

  • Alzheimer’s/dementia ,Arthritis (including rheumatoid and osteoarthritis),Asthma, Atrial fibrillation, Cancer (breast, colorectal, lung, and prostate) , Chronic kidney disease, COPD ,Depression Diabetes (excluding diabetic conditions related to pregnancy), Heart failure, Hyperlipidemia (High cholesterol) Hypertension (High blood pressure) Ischemic heart disease, Osteoporosis Stroke/Transient ischemic attack.

Care management Services:

We do have 7 Care management services based on its own functionality and nature.

  1. Chronic Care Management:

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  1. Complex Chronic Care Management

60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

Required Elements for Chronic and Complex Chronic care Management:

  1. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
  2. Comprehensive care plan established, implemented, revised, or monitored.
  3. Moderate or high complexity medical decision making
  4. Establishment or substantial revision of a comprehensive care plan
  5. Transitional Care Management:

Manage care transitions between and among health care providers and settings, including referrals to other providers, including: ◦ Providing follow-up after an emergency department visit, and after discharges from hospitals, skilled nursing facilities, or other health care facilities.

TCM service Documentation:

Minimum you must document the following information in the beneficiary’s medical record:

  • Date the beneficiary was discharged
  • Date you made an interactive contact with the beneficiary and/or caregiver
  • Date you furnished the face-to-face visit
  • The complexity of medical decision making (moderate or high)
  1. Advance Care Planning: Advance care planning including the explanation and discussions of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified health care professional
  • Involves counseling and discussing advance directives Certain E/M services performed on the same day may be reported separately including ◦ Critical care codes
  • Neonatal and pediatric critical care codes
  • Care management codes
  • Chronic care management codes

5.Annual Wellness Visit: Establishes or updates patient’s medical and family history. Measures height, weight and body mass and blood pressure. Goal is health promotion and disease detection which fosters co-ordination of screening & preventive services that may be already covered, Includes Personalised Prevention Plan Services done on patients who are no longer within the 12 months period after the effective date of their Medicare coverage.

6.Psychiatric Collaborative Care Services:

  • Services provided under direction of treating physician or other qualified health care professional during a calendar month when a patient has been diagnosed psychiatric disorder that requires behavioral health care assessment
  • Establishing, implementing, revising or monitoring a care plan
  • Provision of brief interventions.

Modifier 25:

Modifier 25 is defined as a significant, separately identifiable Evaluation and Management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. If both an E/M and the Chronic care management code are billed on the same day, modifier -25 must be reported on the CCM claim.

Modifier 54. Surgical Care Only.

When a physician or other qualified health care professional performs a surgical procedure and another provides pre-operative and/or post-operative management, surgical services may be identified by adding this modifier to the usual procedure code

If another individual provides TCM services within the post-operative period of a surgical package, modifier 54 is not required