Wiki Transitional Care Management - when billing

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bethb

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Hi!

I am still trying to thoroughly understand when billing the 99495 / 99496 is appropriate. I have a couple of questions and was wondering if anyone had insight or suggestions on te following? (I have read, and re-read the FAQs on CMS' website, AAFP FAQs, and the CPT code book and I am still unsure) Thank you in advance for your information and suggestions!

1. The Communication within 2 business days of discharge--can this be done by the RN or Nurse Case Manager in our office? Can it be done by the Medical Assistants in our office?

2. Can we still bill the code if 2 (documented) attemtps were made to reach the patient but those attempts were unsucessful?

3. Can Care Plan Oversites (G0179, G0180, G0181, and G0182) be billed within the 30 days of the TCM?

Thank you all so much!

Beth B.
 
Hi!

I am still trying to thoroughly understand when billing the 99495 / 99496 is appropriate. I have a couple of questions and was wondering if anyone had insight or suggestions on te following? (I have read, and re-read the FAQs on CMS' website, AAFP FAQs, and the CPT code book and I am still unsure) Thank you in advance for your information and suggestions!

1. The Communication within 2 business days of discharge--can this be done by the RN or Nurse Case Manager in our office? Can it be done by the Medical Assistants in our office?

2. Can we still bill the code if 2 (documented) attemtps were made to reach the patient but those attempts were unsucessful?

3. Can Care Plan Oversites (G0179, G0180, G0181, and G0182) be billed within the 30 days of the TCM?

Thank you all so much!

Beth B.
Click to expand...

Good Afternoon, For your first question, the first contact can be done by any member of your staff. We have an RN and an MA that make up a Care Team in our office, and the two of them are the ones most often to make the contact. There are times, however, when a patient will call and speak to a scheduler and tell them that they were just released from a hospital that we dont share records with. That also counts for the first contact if its documented correctly.

For question #2, it depends. Is it documented that you finally made first contact on the third or fourth day? For us, if we try to get in touch with the patient on the first two days after discharge and are unsuccessful, we document all the attempts. We're usually able to contact the patient by day three and we do bill the TCM codes for that patient. If we are unable to ever get in touch with the patient, but the patient shows up for a previously scheduled appt then we do not bill for the TCM. Others could be doing it differently, but there really isnt alot of information out there about what to do if you cant contact the patient.

For your third question, I believe the answer is no. The TCM codes cover a 30 day period and are bundled with Care Plan Oversight. Per the AAPF: "Do Not bill during the 30 days for Prolonged services (99358, 99359), Care plan oversight (99339, 99340, 99374-99380), Anticoagulant management (99363, 99364), Medical Team Conferences (99366-99368), Education and training (98960-98962, 99071, 99078), and Telephone services (98966-98968, 99441-99443)."

I hope this helps.
 
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