Name of the Procedure:

Coordinated Care Fee, Maintenance Rate (HCPCS Code G9002)

Common name(s): Coordinated Care Maintenance Technical/medical term: G9002 - Coordinated care fee, maintenance rate

Summary

The Coordinated Care Fee, Maintenance Rate (G9002) is a recurring fee billed to support ongoing case management and care coordination services. This fee covers the efforts involved in maintaining continuous care management for patients with chronic or complex medical conditions.

Purpose

The main goal of this procedure is to provide continuous and organized care for patients with chronic illnesses or complex healthcare needs. This helps in maintaining the patient's overall health, reducing hospital admissions, and improving quality of life.

Indications

• Chronic diseases like diabetes, hypertension, COPD
• Mental health conditions requiring ongoing management
• Complex medical conditions needing multidisciplinary care
• Frequent hospital admissions or extensive care requirements

Preparation

No specific preparations needed. Patients may need to ensure they have all their medical records and medication lists ready for comprehensive review by the care team. Initial diagnostic tests and assessments would have been completed during the setup phase of the care plan.

Procedure Description

1. Initial Assessment: A thorough review of the patient's medical history, current condition, and care needs.
2. Care Plan Development: A customized care plan is created.
3. Ongoing Coordination: Regular check-ins and updates with the care team.
4. Review and Adjustment: Periodic reevaluation of the care plan to incorporate any new changes in the patient's condition.

Tools Used: Electronic Health Records (EHR), telecommunication devices, care coordination software. No anesthesia or sedation is required.

Duration

The care maintenance is ongoing and does not have a fixed duration. Regular reviews may happen bi-weekly, monthly, or quarterly based on individual needs.

Setting

This service is typically coordinated from an outpatient clinic or a healthcare provider's office. Telehealth may also be used for remote check-ins.

Personnel

• Primary Care Physicians
• Nurse Practitioners
• Case Managers
• Social Workers
• Pharmacists

Risks and Complications

• Miscommunication between care team members
• Delays in updating care plans
• Rare risks include patient non-compliance or misunderstanding of care recommendations.

Benefits

• Improved management of chronic conditions
• Reduced hospitalizations
• Enhanced patient satisfaction and quality of life
• Timely medical interventions

Recovery

There's no recovery period required as it is a maintenance process. Patients should follow care instructions and attend all scheduled reviews to ensure optimal health management. Follow-up appointments are generally regular and ongoing.

Alternatives

• Independent management by a primary care provider without a care coordination team.
• Use of short-term care coordination services.
• Self-management by the patient with minimal professional involvement.

Pros of alternatives: Lower costs, more autonomy Cons: May not provide the same level of comprehensive care, increased risk of unmanaged conditions

Patient Experience

Patients can expect continuous and comprehensive support for managing their health. They might experience frequent communication with healthcare providers and a more structured approach to managing their illness. Comfort measures include ensuring all their concerns are addressed promptly, and any pain or discomfort related to their conditions is managed effectively.