Because of the insidious nature of chronic kidney disease, and because most people affected do not have symptoms until the condition becomes advanced, it is sometimes under-recognized by busy healthcare providers. According to the National Kidney Foundation, kidney disease affects an estimated 37 million people in the United States. Of these 37 million Americans, approximately 90% of them with chronic kidney disease don’t know they have it. Furthermore, in the United States, 1 in 3 persons above age 18 is at risk for developing chronic kidney disease.¹ 

Despite these statistics, kidney disease is largely preventable with regular, multidisciplinary care. Highly trained clinical pharmacists understand the causes of acute and chronic kidney disease—medication-related and causes not related to medication. These professionals are specially trained to control and decrease risk factors for developing chronic kidney disease through medication management. Two of the most significant risk factors for chronic kidney disease are uncontrolled diabetes and high blood pressure. 

This information should be alarming to the nearly 35 million U.S. adults living with diabetes² and the estimated 47 million Americans living with high blood pressure³. 

In a study that looked at the effect of a pharmacist-physician collaborative care model on patient outcomes and health services utilization, by including clinical pharmacists, patients achieved significant improvement in medication-related clinical health outcomes and reduced hospitalization.⁴ Moreover, in this study, patients who received additional care from a clinical pharmacist benefited from significant improvements in glycosylated hemoglobin and blood pressure, two important risk factors in developing chronic kidney disease. 

A similar study focused more specifically on the pharmacist’s role in managing high blood pressure found similar benefits when pharmacists were on the patient’s care team. In this study, chronic care management (CCM) collaboration between pharmacists and primary care physicians led to meaningful improvements in blood pressure for Medicare beneficiaries with uncontrolled high blood pressure. 

By the end of month 9, the services provided by the pharmacists resulted in a mean drop in systolic blood pressure of 7.3mmHg and a decline in diastolic pressure of 3.0mmHg. At the start of the study, eligible patients had a blood pressure >130/80, with a mean of 140.4/77.9mmHg. At 9 months post-initiation, the mean blood pressure was 133.1/74.9 mmHg. The chronic care management model nearly doubled revenue for both the physician group and the pharmacy practice as an added benefit.⁵ These studies underscore pharmacists’ role in controlling risk factors for several diseases, including chronic and acute kidney disease. 

Though commonly under-recognized, kidney disease is widespread. Chronic kidney disease, in particular, is preventable through health and lifestyle modifications. When detected early and managed properly, patients with kidney disease have the opportunity to live an otherwise healthy life. By working with accessible clinical pharmacists, such as those at PharmD Live®, patients improve their quality-of-life and health outcomes. 

After spending March elevating awareness of kidney disease, PharmD Live® is helping move the needle in the right direction: prevention. We are doing our part by partnering with providers in communities where the prevalence of risk factors is high. PharmD Live® is dedicated to bringing quality- and evidence-based care to patients living with kidney disease.

PharmD Live®’s chronic care solutions apply proprietary AI-driven technology to monitor your patients’ prescriptions, over-the-counter medications, and natural treatments that are harmful to the kidneys and exacerbate poor kidney function. Predictive analytics identify potential issues before they become chronic. Through our metrics-driven, turnkey telehealth solutions, we seamlessly provide personalized care coordination, medication management, and consistent patient engagement for patients, to improve quality and satisfaction scores. For patients with two or more chronic conditions, PharmD Live®’s CCM program supplies auditable reports to physician offices for filing with CMS. 

Our aim with these collaborations is to improve the quality of life and health outcomes for our communities—to educate and affect change. Our pharmacists bridge the gap between knowing and doing.

To learn more about PharmD Live® and the personalized care, pharmacological expertise, and improved outcomes we are committed to providing, visit our website at pharmdlive.com.

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About the author – Ryan Payne is a residency-trained clinical pharmacist serving in the Houston metro area. He received his MS and PharmD from The University of Tennessee Health Science Center in Memphis.

References 

1. National Kidney Foundation. (2021, May 20). Kidney disease: The basics. National Kidney Foundation. Retrieved March 23, 2022, from https://www.kidney.org/news/newsroom/fsindex#fast-facts 
2. American Diabetes Association. (2022, February 4). Statistics About Diabetes. American Diabetes Association. Retrieved March 24, 2022, from https://www.diabetes.org/about-us/statistics/about-diabetes 
3. Centers for Disease Control and Prevention. (2021, September 27). Facts About Hypertension. Centers for Disease Control and Prevention. Retrieved March 24, 2022, from https://www.cdc.gov/bloodpressure/facts.htm 
4. Matzke, G. R., Moczygemba, L. R., Williams, K. J., Czar, M. J., & Lee, W. T. (2018). Impact of a pharmacist–physician collaborative care model on patient outcomes and Health Services Utilization. American Journal of Health-System Pharmacy, 75(14), 1039–1047. https://doi.org/10.2146/ajhp170789 
5. Inman, S. (2019, October 28). Pharmacist and Physician Led Chronic Care Program Improves Hypertension. Drug Topics. Retrieved March 24, 2022, from https://www.drugtopics.com/view/pharmacist-and-physician-led-chronic-care-program-improves-hypertension

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What is Heart Disease?

Heart disease refers to several conditions that affect the heart. These include:

• Blood Vessel Disease (Coronary Artery Disease, CAD): is the most prevalent form in which plaque accumulates in the arteries, narrowing them and leading to reduced blood flow. CAD can result in severe health issues such as myocardial infarction (heart attack) and stroke [[Centers for Disease Control and Prevention, 2023], [American Heart Association, 2024].
• Irregular Heartbeats (Arrhythmias): When the heart beats too fast, slow, or irregularly, leading to symptoms like palpitations, dizziness, or fainting. In severe cases, arrhythmias can cause sudden cardiac arrest [Mayo Clinic, 2024].
• Congenital Heart Defects: Heart abnormalities present from birth, causing symptoms like fatigue, rapid breathing, or cyanosis [Cleveland Clinic, 2023].
• Heart Muscle Disease (Cardiomyopathy): Affects the heart muscle, impairing its ability to pump blood effectively. Symptoms include swelling in the legs, ankles, or abdomen, and shortness of breath [American Heart Association, 2024].
• Heart Valve Disease: Malfunctioning heart valves cause symptoms like shortness of breath, fatigue, swollen feet or ankles, and irregular heartbeats [National Heart, Lung, and Blood Institute, 2024].

Although genetics contribute to heart disease risk, lifestyle changes—such as a healthy diet and regular exercise—play a significant role in reducing the chances of developing heart disease.

Causes of Heart Disease: Understanding Key Risk Factors

The causes of heart disease are multifactorial, with both modifiable and non-modifiable risk factors. Understanding these risk factors is crucial for heart disease prevention. Key causes include:

1. High Blood Pressure (Hypertension): Damages arteries, reducing elasticity and blood flow [Centers for Disease Control and Prevention (CDC)].
2. High Cholesterol: High LDL cholesterol leads to plaque buildup in arteries, increasing heart attack and stroke risk [Mayo Clinic].
3. Smoking: Damages blood vessels, increases plaque buildup, raises blood pressure, and reduces blood oxygen [American Heart Association (AHA)].
4. Lack of Physical Activity: Contributes to weight gain, high blood pressure, and high cholesterol [National Institutes of Health (NIH)].
5. Unhealthy Diet: Diets high in saturated fats, trans fats, sodium, and processed foods contribute to weight gain and related conditions [American Heart Association (AHA)].
6. Diabetes and Insulin Resistance: High blood sugar levels damage blood vessels and nerves controlling the heart [American Diabetes Association].
7. Excessive Alcohol Consumption: Increases blood pressure and can lead to cardiomyopathy and arrhythmias [National Institute on Alcohol Abuse and Alcoholism (NIAAA)].
8. Family History and Genetics: Genetic factors increase susceptibility to heart disease [Centers for Disease Control and Prevention (CDC)].
9. Age and Gender: Risk increases with age, with men developing heart disease earlier than women [National Heart, Lung, and Blood Institute (NHLBI)].
10. Stress: Chronic stress raises blood pressure and promotes unhealthy behaviors [Mayo Clinic].

The Importance of Early Detection and Intervention

Recognizing heart disease early can make a big difference in treatment outcomes. Therefore, regular screenings for blood pressure, cholesterol, and blood sugar are crucial for identifying potential risks before they become serious issues. For example:

• Heart Attack (Myocardial Infarction): Chest pain, shortness of breath, nausea, and sweating [CDC, 2023].
• Stroke: Sudden numbness, confusion, vision problems, and difficulty speaking [American Heart Association, 2024].
• Heart Failure: Swelling in the abdomen or legs, fatigue, and shortness of breath [National Heart, Lung, and Blood Institute, 2024].

Early intervention can significantly improve outcomes.

Heart Disease: Why It Matters

Heart disease is not just a statistic—it affects individuals and families across the country. 

• Leading Cause of Death: Heart disease is the leading cause of death in the U.S., accounting for nearly one in four deaths [Centers for Disease Control and Prevention, 2023].
• Preventable Risk Factors: Many risk factors are preventable through lifestyle changes, medication, and early intervention [American Heart Association, 2024].
• Early Intervention is Critical: Routine screenings can identify risk factors early, leading to more effective treatment.

PharmD Live®’s Proactive Approach

At PharmD Live®, we focus on prevention through Medication Therapy Management (MTM). Our Pharmacists collaborate with healthcare providers to ensure proper medication use, improve adherence, and enhance overall patient care. By working together, we can help prevent heart disease and reduce its impact. At PharmD Live®, we focus on prevention through Medication Therapy Management (MTM) services. Our clinical pharmacists collaborate with healthcare providers to ensure comprehensive care, optimize medication adherence, and reduce medication errors. By prioritizing proactive care, PharmD Live® helps patients better manage heart disease risks and improve health outcomes.

For more details on how PharmD Live® can assist with heart disease prevention strategies, visit our Solutions page or contact us directly

Take Action: Prioritize Heart Health Today

Prioritizing heart health is critical. Whether you’re an individual looking to reduce your risk or a healthcare provider guiding patients through heart disease prevention, taking the right steps today can improve your health tomorrow. Routine screenings, healthy lifestyle changes, and comprehensive medication management are all effective strategies in combating heart disease.

PharmD Live® partners with healthcare organizations to identify individuals at risk and ensure they receive the appropriate care. By focusing on early detection and proactive care, we can collectively reduce the burden of heart disease and improve health outcomes nationwide

References

1. American Diabetes Association (ADA). “Heart Disease and Diabetes.” https://www.diabetes.org/healthy-living/cardiovascular-disease
2. American Heart Association (AHA). “Cardiomyopathy.” https://www.heart.org/en/health-topics/cardiomyopathy
3. American Heart Association (AHA). “Healthy Eating for a Healthy Heart.” https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/healthy-eating-for-a-healthy-heart
4. American Heart Association (AHA). “Smoking and Cardiovascular Disease.” https://www.heart.org/en/health-topics/quit-smoking/smoking-and-cardiovascular-disease
5. American Heart Association (AHA). “Stroke.” https://www.heart.org/en/health-topics/stroke
6. American Heart Association (AHA), 2024. “Heart Disease and Stroke Statistics – 2024 Update.” https://www.heart.org/en/about-us/statistics
7. Centers for Disease Control and Prevention (CDC). “Family History and Heart Disease.” https://www.cdc.gov/heartdisease/risk_factors.htm
8. Centers for Disease Control and Prevention (CDC). “High Blood Pressure.” https://www.cdc.gov/bloodpressure/index.htm
9. Centers for Disease Control and Prevention (CDC), 2023. “Leading Causes of Death.” https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
10. Cleveland Clinic. “Congenital Heart Defects.” https://my.clevelandclinic.org/health/diseases/22144-congenital-heart-defects
11. Mayo Clinic. “Arrhythmia Symptoms.” https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350624
12. Mayo Clinic. “Cholesterol Levels.” https://www.mayoclinic.org/tests-procedures/cholesterol-test/about/pac-20384787
13. Mayo Clinic. “Stress and Heart Disease.” https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
14. National Heart, Lung, and Blood Institute (NHLBI). “Age and Heart Disease.” https://www.nhlbi.nih.gov/health/heart-disease/risk-factors
15. National Heart, Lung, and Blood Institute. “Heart Valve Disease.” https://www.nhlbi.nih.gov/health/heart-valve-disease
16. National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Alcohol and Heart Health.” https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-and-heart-health
17. National Institutes of Health (NIH). “Physical Activity and Heart Disease.” https://www.nhlbi.nih.gov/health/educational/hearttruth/lower-risk/lifestyle.htm
18. National Library of Medicine. “The Decline and Rise of Coronary Heart Disease.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682614/
19. Columbia Surgery, “Heart Disease Was Common in Ancient Egypt, Too.” https://columbiasurgery.org/news/2016/02/18/heart-disease-was-common-ancient-egypt-too-0
20. PMC, “Coronary Heart Disease: From Mummies to 21st Century.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501035/

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The Key CCM CPT Codes Providers Need to Know

There are two primary CPT codes used for billing CCM services: the basic and the complex.

Basic CCM Codes:

1. CPT Code 99490: This code covers at least 20 minutes of clinical staff time spent on non-face-to-face care coordination for patients with two or more chronic conditions. ​
2. CPT Code 99439: An add-on code used to report each additional 20 minutes of clinical staff time beyond the initial 20 minutes covered by CPT 99490. Centers for Medicare & Medicaid Services. 
3. CPT Code 99491: This code is for at least 30 minutes of care management services provided personally by a physician or other qualified healthcare professional.

Complex CCM Codes:

CPT Code 99487: Applies when the patient requires moderate-to-high complexity medical decision-making and at least 60 minutes of clinical staff time in a given month.  Intended for patients needing more intensive, coordinated care.

CPT Code 99489 (Add-on for Complex CCM): Reports each additional 30 minutes of clinical staff time beyond the 60 minutes covered by CPT 99487. Must be billed in conjunction with 99487.

These codes ensure that healthcare providers can be reimbursed for the vital services they offer as part of the CCM program, covering everything from medication management to patient education. Utilizing these codes accurately is not just essential for compensation; it ensures that your practice meets Medicare’s compliance standards.

Billing Restrictions and Modifiers:

When billing for CCM services, it’s crucial to be aware of specific restrictions and the appropriate use of modifiers:

• Concurrent Billing Restrictions: Certain codes cannot be billed concurrently with CCM services within the same calendar month. For instance, CPT codes 99090 and 99091, which pertain to data analysis and interpretation, should not be billed during the same service period as CPT 99490. ​Centers for Medicare & Medicaid Services.
• Modifiers: When billing for CCM services on the same day as an Evaluation and Management (E/M) service, it’s necessary to append modifier -25 to the E/M code to indicate that the patient’s condition required a significant, separately identifiable E/M service beyond the usual care associated with CCM. ​Centers for Medicare & Medicaid Services.

“Incident To” Billing for CCM Services:

CCM services are typically provided by clinical staff under the supervision of a physician or other qualified healthcare professional. These services are billed under the “incident to” provision, meaning they are furnished incident to the professional services of the billing practitioner. This requires that: ​Centers for Medicare & Medicaid Services

• The services are part of the patient’s normal course of treatment during which a physician personally performs an initial service and remains actively involved in the patient’s ongoing care.​
• The services are provided under the direct supervision of the billing practitioner, meaning the practitioner is physically present in the same office suite and immediately available to furnish assistance and direction throughout the performance of the service.​

For comprehensive guidelines on “incident to” billing requirements, refer to the Centers for Medicare & Medicaid Services (CMS) publication on Chronic Care Management Services. ​Centers for Medicare & Medicaid Services.

Why Is Understanding CCM CPT Codes Crucial for Providers?

1. Maximizing Reimbursement
   Correct use of CPT codes enables healthcare providers to maximize reimbursement for the services they render. It ensures that all CCM services provided, whether medication management, chronic disease management, or health monitoring, are financially recognized.
2. Compliance and Risk Management
   Properly documenting and billing using the right codes ensures compliance with Medicare policies, reducing the risk of audits, fines, or penalties. Staying compliant guarantees that your practice stays financially and legally sound.
3. Enhancing Care Delivery
   Accurate coding is not only about reimbursement; it ensures that healthcare providers have a structured approach to managing chronic conditions, leading to better health outcomes and patient satisfaction.
4. Improved Efficiency
   By understanding the different CCM CPT codes, providers can streamline their workflow, reduce administrative burdens, and ensure that each patient’s care is billed correctly, leading to greater overall operational efficiency.

PharmD Live®’s Role in Optimizing CCM Coding and Care Coordination

At PharmD Live®, we specialize in optimizing CCM services to improve patient outcomes and practice efficiency. We assist providers in correctly applying CCM CPT codes and navigating the complexities of billing, helping them avoid costly errors and ensuring that all patient interactions are accurately reflected in claims. By leveraging our expertise, practices can enhance revenue streams, reduce administrative burdens, and focus on delivering high-quality patient care.

Conclusion: Unlock the Full Potential of CCM with Proper Coding

Mastering the intricacies of CCM CPT codes, billing restrictions, and “incident to” requirements is vital for healthcare providers committed to delivering comprehensive care to patients with chronic conditions. Accurate coding and adherence to Medicare guidelines ensure appropriate reimbursement and enhance care delivery and patient satisfaction. PharmD Live® stands ready to assist practices in navigating these complexities, offering tailored solutions that align with the evolving healthcare landscape.

Curious how CCM fits into your care strategy?

Get the full breakdown of how PharmD Live®'s CCM model supports patients and providers alike.

References:

• CMS – Chronic Care Management Services Fact Sheet
• CMS – Chronic Care Management Toolkit
• CMS – Care Management Services Overview
• CMS – Frequently Asked Questions About Billing Medicare for CCM Services
• AMA – CPT® Evaluation and Management (E/M) Code and Guideline Changes
• Medicare.gov – Chronic Care Management Coverage

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