Cardiology Coding Alert

CPT® and CMS guidelines are more in sync.

CPT® 2014 takes advantage of a year’s experience to adjust guidelines for TCM codes 99495-99496 (Transitional care management services with the following required elements: Communication [direct contact, telephone, electronic] with the patient and/or caregiver within two business days of discharge…)

“We know some practitioners [had] challenges billing for transitional care management,” said CMS’s Chris Ritter in an open door forum regarding the CPT® 2013 codes.

Now CPT® 2014 makes changes to clear up some of the problems. Although the codes don’t change in 2014, the guidelines do.

Get to Know Guideline Revisions

The CPT® Editorial Panel accepted guideline revisions to indicate that TCM services can now also apply to new patients. The 2013 guidelines limited the codes to established patients, but payers such as Medicare already allowed the use of the codes for new patients in 2013, too.

You also get clarifications about reporting discharge services and other E/M services in addition to TCM. “Both the 2013 and 2014 guidelines state that additional E/M services after the first face-to-face may be reported separately,” notes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “However, the 2014 guidelines make explicit that those additional E/M services must occur on subsequent dates,” adds Moore.

Discharge not enough: The 2013 and 2014 guidelines both “state that the same individual may report hospital or observation discharge services and TCM,” says Moore. But “the 2014 guidelines add the qualification that the discharge service may not constitute the required face-to-face visit.”