CKD APCM Billing Code Setup & Workflow Checklist

Verify your facility type for G0511 or G0512 eligibility when managing CKD stages 3a through stage 5.

Ensure N18.3, N18.4, or N18.5 codes are used to justify the medical necessity of intensive chronic care management.

Implement a system to track at least 20 minutes of non-face-to-face care coordination per calendar month.

Record the most recent eGFR and creatinine levels in the APCM enrollment documentation for clinical tracking.

Check if patients are enrolled in Medicare ESRD programs to avoid duplicate billing for dialysis-related services.

Document monthly reviews of medication dosing, specifically looking for drugs requiring adjustment as eGFR declines.

Outline monitoring schedules for hemoglobin and iron saturation levels within the electronic care plan.

Schedule and document calcium, phosphorus, and PTH monitoring intervals based on the patient's CKD stage.

Include specific patient education goals for sodium, potassium, and phosphorus restriction in the APCM record.

Establish and document blood pressure targets (e.g., <130/80) as part of the core CKD progression delay strategy.

Deploy AI voice calls to remind patients of upcoming eGFR and albuminuria screenings to prevent care gaps.

Use automated AI check-ins to ask patients about sudden weight gain, edema, or shortness of breath between visits.

Schedule automated outbound calls to provide tips on low-potassium snacks and sodium reduction strategies.

Implement AI-driven medication adherence checks specifically for binders and other renal-specific prescriptions.

Automate follow-up calls for patients referred for transplant evaluation to ensure they complete necessary testing.

Ensure all AI-driven patient interactions are timestamped and logged in the EHR to count toward APCM time requirements.