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Topics in Practice Management |

Chronic Care CoordinationChronic Care Coordination, Case Management

Steve G. Peters, MD, FCCP; Kari S. Bunkers, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Peters), Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN; and Department of Family Medicine (Dr Bunkers), Mayo Clinic Health System, Owatonna, MN.

CORRESPONDENCE TO: Steve G. Peters, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 SW First St, Rochester, MN 55905; e-mail: Peters.Steve@Mayo.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):1115-1119. doi:10.1378/chest.15-0704
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Chronic care management describes the services provided to patients with two or more chronic conditions that pose risks of exacerbation, clinical deterioration, or death. These services extend beyond the typical face-to-face office visit and require coordination and oversight by a physician or other qualified health-care professional to maintain and modify as necessary a comprehensive and multidisciplinary plan of care. New codes for 2015 describe chronic care management services per calendar month. While the new services acknowledge the role and importance of coordination by primary care providers, they are also appropriate for specialists who oversee the management of all of the chronic conditions of a patient and provide access, education, care coordination, communication, and health information exchange with other providers.


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