Case management, per month
HCPCS code
Name of the Procedure:
Case Management, per month
Common Names: Case Management, Care Coordination
Technical Terms: T2022
Summary
Case management involves coordinating care and resources for patients with complex healthcare needs on a monthly basis to ensure they receive comprehensive and continuous medical care.
Purpose
Medical Conditions Addressed: Chronic illnesses, multiple comorbidities, recovery after major surgery, severe injuries, mental health conditions.
Goals: Enhance patient outcomes, streamline access to healthcare services, reduce hospital readmissions, improve overall quality of life.
Indications
Symptoms/Conditions: Frequent hospitalizations, need for multiple healthcare providers, difficulty managing medical regimens, high healthcare costs.
Patient Criteria: Patients with chronic diseases, elderly patients, those recovering from major procedures or trauma, patients with mental health challenges.
Preparation
Instructions: Generally, no special preparation is needed. However, patients may need to provide medical history and current medication lists.
Assessments Required: Comprehensive health assessment, social needs evaluation, medication review.
Procedure Description
The case management process involves:
- Assessment: Initial evaluation of health, social, and functional status.
- Planning: Developing a personalized care plan.
- Coordination: Arranging services and resources required for the care plan.
- Implementation: Ensuring the care plan is being followed.
- Monitoring: Regular follow-ups to assess progress and adjust the care plan as needed.
Tools/Equipment: Electronic health records, telehealth platforms.
Anesthesia/Sedation: Not applicable.
Duration
Case management is ongoing and typically reviewed monthly.
Setting
Performed in various settings, including hospitals, outpatient clinics, home health agencies, or via telehealth.
Personnel
Involves a team of healthcare professionals including:
- Case managers or care coordinators (usually nurses or social workers)
- Physicians
- Specialists
- Pharmacists
- Physical and occupational therapists (if necessary)
Risks and Complications
Common Risks: Minimal risks, may include miscommunication, coordination delays.
Possible Complications: Rare, but can include potential errors in care planning if communication fails. Managed with regular follow-ups and clear communication protocols.
Benefits
Expected Benefits: Improved health outcomes, more efficient use of healthcare services, reduced healthcare costs, enhanced patient satisfaction.
Timeline for Benefits: Benefits may be seen within months as care becomes more coordinated and comprehensive.
Recovery
Post-Procedure Care: Continuous engagement with the care manager. Follow-up appointments are scheduled as needed.
Expected Recovery Time: Not applicable, as it is an ongoing service.
Restrictions/Follow-Up: Patients should adhere to the care plan and report any issues to the case manager promptly.
Alternatives
Other Options: Direct patient management by primary care provider, self-management with patient education resources.
Pros and Cons: Direct management can be less coordinated, while self-management may lack professional oversight.
Patient Experience
During the Procedure: Patients will interact regularly with their case manager, often via phone or in-person appointments.
After the Procedure: Continued support and monitoring. Feedback on the patient's experience is used to adjust care plans. Pain Management: Not applicable, but emotional and psychological support is often provided.