Rheumatology APCM Billing Code Setup Checklist

Secure verbal or written consent for APCM services, explaining cost-sharing and the 24/7 access model essential for flare management.

Confirm the patient has two or more chronic conditions, such as Rheumatoid Arthritis and Hypertension, expected to last at least 12 months.

Create a digital care plan in the EHR addressing biologic therapy, physical therapy goals, and immunosuppression risks.

Set up automated timers within your EHR to capture non-face-to-face time spent on coordination and lab reviews.

Implement AI-powered call handling to ensure patients can report autoimmune flares or medication side effects at any time.

Create templates for documenting the review of CBC, LFTs, and Creatinine for patients on Methotrexate or JAK inhibitors.

Track time spent communicating with specialty pharmacies to ensure biologic delivery and prior authorization continuity.

Document activities related to Risk Evaluation and Mitigation Strategies required for specific rheumatologic biologics.

Track annual screening requirements for patients on TNF inhibitors to ensure safety and clinical protocol adherence.

Capture time spent counseling immunosuppressed patients on Shingrix, Prevnar, and annual flu vaccinations.

Use automated phone systems to categorize the severity of RA or Gout flares and route them to the clinical team immediately.

Record all time spent instructing patients on Prednisone tapers or temporary cessation of biologics during infection.

Automate the collection of RAPID3 or CDAI scores via phone or portal to monitor disease activity between visits.

Document time spent ordering and reviewing urgent CRP/ESR labs during suspected inflammatory escalations.

Schedule and document a follow-up call 48 hours after a medication adjustment to ensure symptom improvement.

Bill for the initial 20 minutes of clinical staff time directed by a physician for chronic care coordination.

Apply this add-on code for each additional 20 minutes spent on complex rheumatology cases exceeding the initial threshold.

Review automated call logs and summaries to ensure they meet CMS documentation standards for non-face-to-face care.

Ensure your billing department distinguishes between standard CCM and the newer APCM requirements for rheumatology.

Generate a monthly report of all staff interactions, lab reviews, and pharmacy coordination per patient for audit safety.