WHAT PHYSICIANS/CLINICIANS SHOULD KNOW: KNOWLEDGE SERIES COMPLEX CHRONIC CARE MANAGEMENT Complex Chronic Care Management CMS recognizes that some patients are more complex and will require more than 20 minutes provided by regular chronic care management. For these patients, complex chronic care management will be the better program. This requires more time from the provider and staff (60 mins/month), provider oversight of the care plan as well as moderate to severe complexity of medical decision-making. We recognize that the complexity of medical decision-making may not be something everyone is familiar with. This document was designed to clarify this. NATURE & NUMBER OF CLINICAL PROBLEMS AMOUNT & COMPLEXITY OF DATA REVIEWED RISK OF MORBIDITY & MORTALITY TO THE PATIENT 1 2 3 To determine qualification for complex CCM you must reach moderate complexity in two out of three of these areas: • One or more chronic illnesses with mild exacerbation, progression or side effects of treatment • Two or more stable chronic illnesses • Undiagnosed new problem with uncertain prognosis (e.g., lump in breast) • Acute illness with systemic symptoms (e.g., pyelonephritis, pneumonitis, colitis) • Acute complicated injury (e.g., head injury with brief loss of consciousness) • Physiologic tests under stress (e.g., cardiac stress test, fetal contraction stress test) • Diagnostic endoscopies with no identified risk factors • Deep needle or incisional biopsy • Cardiovascular imaging studies with contrast and no identified risk factors (e.g., arteriogram, cardiac catheterization) • Obtain fluid from body cavity (e.g., lumbar puncture, thoracentesis, culdocentesis) • Minor surgery with identified risk factors • Elective major surgery (open, percutaneous or endoscopic) with no identified risk factors • Prescription drug management • Therapeutic nuclear medicine • IV fluids with additives • Closed treatment of fracture or dislocation without manipulation Medical Decision Making (MDM) Severity www.CaravanHealth.com CCM-006-20190520-APP | Proprietary & Confidential, Do Not Distribute

Medical Decision Making (MDM) Severity 1 2 3...culdocentesis) •Minor surgery with identiﬁed risk factors • Elective major surgery (open, percutaneous or endoscopic) with no identiﬁed

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Page 1: Medical Decision Making (MDM) Severity 1 2 3...culdocentesis) •Minor surgery with identiﬁed risk factors • Elective major surgery (open, percutaneous or endoscopic) with no identiﬁed

WHAT PHYSICIANS/CLINICIANS SHOULD KNOW:

KNOWLEDGE SERIES COMPLEX CHRONIC CARE MANAGEMENT

Complex Chronic Care Management

CMS recognizes that some patients are more complex and will require more than 20 minutes provided by regular chronic care management. For these patients, complex chronic care management will be the better program. This requires more time from the provider and staff (60 mins/month), provider oversight of the care plan as well as moderate to severe complexity of medical decision-making.

We recognize that the complexity of medical decision-making may not be something everyone is familiar with. This document was designed to clarify this.

NATURE & NUMBER OF CLINICAL PROBLEMS

AMOUNT & COMPLEXITYOF DATA REVIEWED

RISK OF MORBIDITY & MORTALITY TO THE PATIENT

1 2 3

To determine qualification for complex CCM you must reach moderate complexity in two out of three of these areas:

• One or more chronic illnesses withmild exacerbation, progression orside effects of treatment

• Two or more stable chronicillnesses

• Undiagnosed new problem withuncertain prognosis (e.g., lump inbreast)

• Acute illness with systemicsymptoms (e.g., pyelonephritis,pneumonitis, colitis)

• Acute complicated injury (e.g.,head injury with brief loss ofconsciousness)

• Physiologic tests under stress (e.g.,cardiac stress test, fetalcontraction stress test)

• Diagnostic endoscopies with noidentified risk factors

• Deep needle or incisional biopsy• Cardiovascular imaging studies

with contrast and no identified riskfactors (e.g., arteriogram, cardiaccatheterization)

• Obtain fluid from body cavity (e.g.,lumbar puncture, thoracentesis,culdocentesis)

• Minor surgery with identified riskfactors

• Elective major surgery (open,percutaneous or endoscopic) withno identified risk factors

• Prescription drug management• Therapeutic nuclear medicine• IV fluids with additives• Closed treatment of fracture or

dislocation without manipulation

Medical Decision Making (MDM) Severity

www.CaravanHealth.comCCM-006-20190520-APP | Proprietary & Confidential, Do Not Distribute

COMPLEX CHRONIC CARE MANAGEMENTKNOWLEDGE SERIES

Complex CCM: Example Patient

Max is an 83 year male with CHF and HTN. He comes in with a complaint of ankle swelling and says he has missed two doses of his diuretics in the past couple of weeks. The patient is examined and diagnosed with a mild exacerbation of his heart failure.The clinician discusses the importance of continuing to follow his regimen to avoid hospitalization and refers him to your population health nurse to begin complex chronic care management.

He qualifies due to:• One or more chronic illnesses with mild exacerbation, progressionor side effects of treatment

• Prescription drug management

• Need to determine if his current regimen in adequate and checkrenal function if dose escalates

G0506

N/A $64

99494

99487Complex CCMSummary

$47

www.CaravanHealth.com

CCM 'add-on' for clinician time spent beyond usual effort in the initiating visit only

Complex CCM

Complex CCM 'add-on' to 99487 for additional staff time