How to Code for Chronic Care Management of Patients With one Disease

Primary care pediatricians spend much of their time in non-direct care, particularly for patients with chronic medical conditions. Phone calls to pediatric subspecialists, pharmacies, and schools; note-writing; care plan management, and medical record review are among the tasks that usually are not separately payable.

The only non-direct care codes in the Current Procedural Terminology (CPT) code set require time spent by a physician (care plan oversight) for more than one chronic condition (chronic care management). However, most pediatric patients typically have only one chronic condition, and the time often is spent by clinical staff rather than the physician.

A pediatrician sees a 7-year-old with acute status asthmaticus who has been in and out of the hospital for several months. It is determined that there are housing and medication management issues. The physician determines the patient needs to be monitored more closely, and a care management plan is developed.