Cardiology APCM Billing Code Setup Checklist

Review EHR data to find patients with chronic heart failure and at least two other qualifying conditions like hypertension or CKD.

Target patients on long-term warfarin or DOACs for Afib management, as they require frequent monitoring and education.

Differentiate between standard (G0557) and complex (G0558) based on the number of chronic conditions and medical decision-making complexity.

Ensure the EHR contains a timestamped record of the patient's agreement to participate in the APCM program and their understanding of cost-sharing.

Create a specific workflow for patients recently discharged after a myocardial infarction to ensure they enter the APCM pathway immediately.

Establish a system, such as an AI-powered voice assistant, that provides patients with 24/7 access to clinical advice or urgent triage.

Develop a digital care plan that includes cardiology-specific goals like target blood pressure and fluid restriction limits.

Systematically track and document all changes to cardiac medications, specifically focusing on GDMT titration for heart failure.

Use standardized tools to assess physical and cognitive functional needs as part of the monthly APCM clinical review.

Maintain a log of all preventive cardiac screenings and annual wellness visits to satisfy CMS requirements for holistic care.

Deploy automated calls to check on patients within 48 hours of hospital discharge to confirm medication pickup and follow-up appointments.

Utilize AI voice agents to conduct weekly adherence checks for high-risk medications like anticoagulants and antiplatelets.

Configure the system to immediately alert a nurse or cardiologist if a patient reports symptoms like peripheral edema or sudden weight gain.

Implement scheduled check-ins to monitor patient progress and symptoms during the weeks between formal cardiac rehabilitation sessions.

Ensure all AI-patient interactions are transcribed and synced to the patient record to provide an audit trail for billing minutes.