Maintaining a balance between acute and chronic care is a standard routine for internal medicine practices. But that balance becomes challenging and often costly when it comes to offshore medical coding and billing  services in India.

Each month, medical practices lose out on hundreds or even thousands of dollars due to incorrect CPT codes, missing patient information, or inaccurate time tracking. To help internal medicine practitioners avoid common billing mistakes, this blog walks through how to code for both chronic and acute care services correctly.

Why Mastering CPT Codes Matters

Medicare reimburses Chronic Care Management (CCM) services such as medication management, monthly follow-ups, and ongoing care planning. However, many providers either underbill or stop billing entirely due to complex regulations, multiple CPT code options, and subtle differences in supervision requirements. On the other hand, acute care Evaluation & Management (E/M) services bring their own challenges due to updates like new telehealth codes and add-on billing for visit complexity.

Chronic vs. Acute Care

Chronic Care Management is designed for patients with two or more chronic conditions that are expected to last at least 12 months or until death. These services are non-face-to-face and often delivered remotely. Such care includes time-tracking, care planning, and obtaining the patient’s consent.

On the other hand, acute care includes in-person assessment and management of sudden symptoms or worsening conditions. These can be infections, injuries, or mental health episodes. The ultimate goal of such care is immediate diagnosis, treatment, or stabilization.

For example, if a patient visits for diabetes and hypertension follow-up, CCM codes apply. If the same patient presents to the emergency department a few weeks later with chest pain, acute care E/M codes are appropriate for that visit.

Chronic Care Management CPT Codes

Chronic Care Management services are billed using specific CPT codes to ensure ongoing patient care with multiple chronic conditions. These codes are divided into two categories:

Non-Complex CCM Codes

• 99490 is the base code for standard non-complex CCM. It covers 20 minutes of care coordination per calendar month. On average, reimbursement of this code amounts to around $60.49.
• 99439 can be added to 99490 for additional 20-minute increments. It can be billed up to two times in a month for a total of 60 minutes. Each unit reimburses around $45.93.
• 99491 is used when the billing provider (physician or qualified healthcare professional) personally provides the first 30 minutes of CCM services. It requires a detailed care plan and accurate time tracking.
• 99437 is an add-on to 99491 and cannot be used independently. It allows additional 30-minute increments and is used when care requires extended provider involvement.
• G0511 is a code specific to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). It reimburses about $74.20 nationally.

However, G0511 has been retired on July 1, 2025, after which RHCs and FQHCs have been switched to standard codes like 99490, 99439, 99491, or 99437.

Complex CCM Codes

• 99487 is used when care coordination is more intensive and lasts at least 60 minutes. It covers patients needing moderate-to-high complexity decision-making. It cannot be billed in the same month as 99491 or 99437.
• 99489 is an add-on to 99487 for each additional 30 minutes of care. It can be billed multiple times based on actual time spent, provided the documentation justifies the complexity.

Important: You cannot bill both complex (99487, 99489) and non-complex (99490, 99491, 99437) CCM codes for the same patient in the same month. You should choose the right category based on complexity and provider involvement.

How to Avoid Errors

• Use 99490 and 99439 when the patient has stable but ongoing care needs that require routine coordination.
• Use 99487 and 99489 when managing more complex patients with frequent changes in medications, multiple specialist involvement, or rapidly evolving care goals.

Acute Care CPT Codes

Acute care billing typically involves in-person Evaluation & Management (E/M) codes used for sudden or worsening medical conditions. These codes depend on factors like complexity, time spent, and location of care.

• 99221 code is used for initial hospital or observation care involving low-complexity conditions and typically requires 30 minutes of provider time.
• 99222 is used for initial hospital or observation care with moderate-complexity decision-making and usually involves about 50 minutes of work.
• 99223 is a high-complexity admission code that applies to serious or unstable conditions and reflects approximately 70 minutes of provider time.
• 99231 is used for low-complexity daily inpatient or observation follow-up visits and involves about 25 minutes and problem-focused documentation.
• 99232 is appropriate for moderate-complexity follow-up visits and requires around 35 minutes of evaluation and care planning.
• 99233 is used for high-complexity daily follow-ups and includes a comprehensive reassessment and typically requires about 50 minutes.
• 99238 is a discharge management code that applies when 30 minutes or less is spent on final inpatient or observation discharge duties.
• 99239 is used when more than 30 minutes is required for discharge planning, including medication review and care coordination.
• 99281 is used in emergency departments for minimal problems requiring limited provider involvement and no significant decision-making.
• 99282 is used for low-complexity emergency visits and involves a problem-focused exam and straightforward medical decision-making.
• 99283 is appropriate for moderate-complexity emergency cases that require expanded evaluation and management.
• 99284 is used for moderately high-complexity ED visits and applies to more urgent conditions requiring detailed assessment.
• 99285 is for high-complexity or potentially life-threatening emergency conditions requiring comprehensive care and documentation.

How to Avoid Errors

• Medical necessity must justify the service level and code.
• Documentation should include a relevant history, examination, and decision-making process, or total time spent, depending on how the code is billed.
• Time-based billing is valid if more than 50% of the visit was dedicated to counseling or care coordination.
• Typically, only one E/M code per patient, per day, per provider group is allowed.

Conclusion

It is essential to understand the difference between CPT codes for chronic and acute care for accurate billing, improved reimbursement, and compliance with Medicare guidelines. Though chronic care codes focus on ongoing, coordinated management of long-term conditions, acute care E/M codes are used for in-person treatment of urgent or newly emerging health issues. Thereby, proper documentation, time tracking, and code selection not only ensure appropriate reimbursement but also reflect the quality of care delivered.

To further streamline your billing process and minimize administrative burden, you can partner with outsourcing medical billing and coding services providers in India. With deep expertise in CPT coding, compliance, and end-to-end revenue cycle management, InfoHub Consultancy Services helps healthcare providers improve accuracy, accelerate reimbursements, and maintain full regulatory compliance. So, what are you waiting for? Contact the experts right now to have a better understanding of chronic and acute care CPT codes.

FAQs

1. Can I bill both chronic and acute care codes for the same patient in one month?
Only if services are separate, distinct, and adequately documented.

2. Does time tracking software help with chronic care billing?
Automated logs ensure compliance and reduce audit risk.

3. Are there tools that help determine the correct CPT code?
AI-based coding assistants and EHR-integrated prompts are widely used.

4. Is telehealth billing different for chronic vs. acute care?
Chronic care allows non-face-to-face codes, while acute care usually requires live interaction.

5. What audits are common with chronic care billing?
Time documentation, consent forms, and care plan completeness are top focus areas.

6. Can CCM codes be used in behavioral health?
If the patient meets eligibility and the conditions are chronic.

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