For years, Priority Consult Spine has advocated for nurse navigation programs. We have argued that nurse navigation raises the level of care provided to patients, provides a competitive advantage for spine centers and increases the capture of ancillary services. The ROI of a nurse navigation program, however, was rather subtle and required hospitals to search through data, cross-reference medical record numbers and basically jump through hoops to prove. As of January 1, 2013, new CPT codes have the potential to change this situation and make it easier to directly tie revenue to a nurse navigation program or spine center.
New Current Procedural Terminology (CPT) codes, introduced by the American Medical Association at the beginning of the year, provide reimbursement for activities that our clients have been providing free-of-charge for ten years. The codes cover care coordination services provided to patients who are either being discharged from the hospital or dealing with multiple medical conditions. An article published by American Medical News reviews these new codes. Two of the new codes, 99496 and 99495, cover care coordination services provided by physicians. The former code refers to a discussion between the physician and patient (not necessarily in person) within two days of discharge. The latter code covers a meeting between a physician and patient, in person, within two weeks of discharge from the hospital.
The new codes that cover care coordination services provided by nurse navigators are 99487, 99488 and 99489. 99487 should be used if non-physician staff members, such as nurse navigators, spend more than an hour in 30 days coordinating care for a patient. 99488 covers the same amount of care coordination, but also includes a meeting in person and 99489 covers additional time spent coordinating care over one hour, in thirty minute periods.
The article recommends a three-step process that hospitals should undergo in order to use these new codes.
1. Contact your payers to see how they are currently reimbursing for these codes. You will need to complete this step in order to estimate how much additional revenue your nurse navigation program could bring in.
2. Find out how to use the codes properly and actually receive reimbursement for them. When you contact your payers, find out exactly how to use these codes and what supporting documentation they will require. It is undoubtedly going to be very important for nurse navigators to track exactly how much time they spend on these covered activities, per patient, per 30 minute period. I will discuss this further momentarily.
3. Communicate with other departments within your hospital to determine when these covered services would be appropriate. For instance, it is difficult to provide post-discharge services if you do not know when your patients are discharged from the hospital. Opening up channels of communication with key departments will allow nurse navigators to provide additional services, thereby generating additional revenue.
Going back to the concept of measuring how much time is spent on care coordination activities… Priority Consult Spine can be modified to assist in that process. We would like to hear from our clients who plan to begin using these CPT codes so we can form a group of nurse navigators and spine center administrators to brainstorm the ideal format for time-tracking within Priority Consult Spine.
If you currently use Priority Consult Spine, what do you think about these new CPT codes? Do you believe that you will be able to use them to charge for your nurse navigation services? Or, do you work with oncology patients and want to investigate these codes for your use? Either way, I would invite you to read the article mentioned and share your thoughts with me.