What the new primary care patient management code means for your practice

Alexandria Foley, MSN, RN

Time is back on your side. The Medicare Advanced Primary Care Management (APCM) codes released in January recognize the value of continuous, complex patient care provided by health care providers in primary care settings without the previous minimum time requirements. The Centers for Medicare and Medicaid is crediting primary care physicians and staff for the patient management tasks that many already perform but may not bill Medicare for given the previous need to demonstrate, for example, at least 30 minutes a month for principal care management or a minimum of 20 minutes for non-complex chronic care.

Many primary care offices do not have the bandwidth or staff needed to document and attest to the time it takes to perform these essential services.

Now, however, when they monitor chronic patients for disease exacerbations, medication changes, follow-up care, specialist referrals, and more as standard practice between visits, they can bill Medicare based on the severity and needs of these chronic care patients using the new APCM codes GO556, GO557, and GO558. Bundled payments reflect patient complexity, with codes that differ according to one chronic condition or none versus two or more, for example.

Part of the Medicare APCM requirements state that continuous, proactive care includes remote evaluations of pre-recorded patient information. A primary care practice can meet this standard by partnering with a firm that offers remote care services including remote patient monitoring (RPM) and care coordination by a care team. The physiological data collected by RPM together with care coordination and APCM coding creates the potential to identify emerging health issues sooner and reduces the need for patients to seek emergency or urgent care.

With these new APCM codes, Medicare is acknowledging primary care providers manage complex patients and provide care planning, education, and follow-up. Care management also means checking in to make sure patients have access to their medication and are adhering to their treatment plans. When qualified health care professionals, particularly registered nurses, validate and interpret RPM data while simultaneously providing care management, they can deliver immediate value to both providers and patients. This approach transforms raw data into actionable insights that drive better patient outcomes.

Overall, these APCM codes are exciting because they are dedicated to the primary care world. At the same time, specialists still have access to chronic care management and principal care management billing options. APCM codes give primary care providers a broader space to get reimbursed for their care coordination and management.

Capturing the tasks that comprise APCM also impacts future care initiatives and reimbursement policies. Reporting and tracking these chronic care services will influence resources, coding, incentives, opportunities, and programs. This will allow providers to continue to manage patients in chronic disease states in an optimal way by putting the resources in the right places for the right people.

With these new codes, the Centers for Medicare and Medicaid recognize that primary care providers play a primary role in comprehensive care management in a more practical way. Doctors, nurses, and staff have multiple touchpoints with patients every month, virtually, remotely, and in person during clinical visits. Some of these essential interactions are brief, such as the two minutes it can take to update a prescription online. Before these coding changes, busy practitioners had to stop and note the increments of time required for each task to meet minimum monthly requirements for reimbursement. With APCM codes GO556, GO557, and GO558, however, management of people with chronic conditions is off the clock, meaning primary care physicians can stop being timekeepers and instead focus more time and energy caring for each of their chronic disease patients.

Alexandria Foley, MSN, RN, is the Chief Nursing Officer at Brook Health