1. Capture the Full Scope of Services
✔ Bill for chronic care management, annual wellness visits, and preventive exams
✔ Include problem-focused visits on the same day using appropriate modifiers
✔ Track time-based visits accurately for prolonged services
2. Use the Right ICD-10 and CPT Codes
✔ Match diagnosis codes with the level of medical decision-making
✔ Link multiple diagnoses when managing co-morbidities
✔ Update coding regularly to reflect new CMS guidelines
3. Preventive vs. Problem Visit Billing
✔ Use modifier 25 when billing a preventive and problem visit on the same day
✔ Document both services clearly and separately in patient records
✔ Inform patients of any cost-sharing when additional services are billed
4. Chronic Condition Management
✔ Enroll eligible patients in CCM and TCM programs
✔ Document care coordination time and communication outside the office
✔ Bill monthly for ongoing non-face-to-face management
5. Common Challenges & Fixes
| Challenge | Fix |
| Claims denied for duplicate services | Use proper modifiers and link services to documentation |
| Confusion between preventive and problem visits | Train providers on documentation and coding requirements |
| Underbilling chronic care services | Identify eligible patients and implement tracking tools |
| Missed billing for care coordination | Use EMR alerts to flag CCM and TCM opportunities |
