APCM Billing Code Setup Checklist for Endocrinology

Use EHR filters to pull patients with A1C > 8.0 or multiple comorbidities like hypertension and obesity for APCM enrollment.

Confirm patients have at least two qualifying conditions such as Type 2 Diabetes and Metabolic Syndrome as per CMS guidelines.

Document personalized goals for insulin titration, weight management, and glucose monitoring within the patient record.

Use AI-driven calls to explain APCM benefits and obtain verbal or written consent, documenting the date and time in the EHR.

Ensure E11.9 (Type 2 DM) and related codes are correctly linked to the APCM service period in the billing software.

Set up time-tracking logs for non-face-to-face care coordination, including phone titration and medication adjustments.

Configure AI agents to call patients monthly to collect recent glucose readings and remind them of upcoming lab work.

Use automated workflows to contact patients 48 hours after a dosage change to monitor for hypoglycemia symptoms.

Schedule AI calls for patients on Levothyroxine to ensure daily compliance and screen for hyper/hypo symptoms.

Provide automated troubleshooting scripts for CGM sensors to reduce the burden on clinical staff during outreach.

Deliver monthly coaching via AI to satisfy the behavioral health components of APCM for obesity and hypertension.

Automate the notification process for normal TSH or A1C results to free up nurses for high-risk patient interventions.

Update your billing system for the specific APCM bundles or G-codes used by your payer mix (Medicare vs. Private).

Review monthly logs to ensure at least 20 minutes of clinical staff time is documented for each billed patient.

Verify that APCM is not being billed alongside CCM or RPM unless specific exceptions for the month are met.

Monitor the percentage of eligible diabetic patients who transition from standard care to the APCM model.

Integrate AI call duration data directly into the billing module to automate the 20-minute time calculation.

Ensure all AI call recordings and patient metabolic data are stored in a HITRUST-certified environment.

Cross-reference care plan templates with the latest American Diabetes Association Standards of Medical Care.

Link APCM activities to MIPS measures like 'Diabetes: Hemoglobin A1c Poor Control' to maximize incentive payments.

Maintain a digital paper trail of all patient outreach, including unsuccessful call attempts and follow-up scheduling.

Use AI to conduct brief surveys regarding the care coordination experience to meet quality improvement goals.