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29.2.12.1 Face-to-Face Clinician-Directed Care Coordination Services
Face-to-face care coordination services are encompassed within the various levels of E/M services and prolonged services.
Providers should use the most appropriate face-to-face E/M procedure codes to bill for care coordination services.
• When counseling or care coordination requires more than 50 percent of the client or family encounter (face-to-face time in the office or other outpatient setting, or floor or unit time in the hospital), then time may be considered the key or controlling factor to qualify for a particular level of E/M service.
•Counseling is discussion with the client or family, concerning diagnostic studies or results, prognosis, risks and benefits, management options, importance of adhering to the treatment regimen, and client and family education.
An E/M procedure code for a face-to-face problem-focused care coordination visit may be billed on the same day as a preventive medicine visit. Modifiers must be used as appropriate for billing.
Any face-to-face inpatient or outpatient E/M procedure code that is a benefit of the CSHCN Services Program, except for hospital discharge-day management (procedure codes 99238 and 99239) and discharge from observation (procedure code 99217), may be billed on the same day as any non-face-to-face clinician-directed care coordination (procedure codes 99339, 99340, 99358, 99359, 99367, 99374, 99375, 99377, and 99378), when the client requires significant, separately identifiable E/M service by the same physician on the same day.
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