tcm

  1. B

    Wiki MCP and TCM

    can you bill 99495 & 99496 the same month of MCP (90960,90961,90962) if both are done in the dialysis facility? If so where can I find documentation please
  2. A

    Wiki 2022 TCM

    Has anyone verified with CMS if 97/95 E&M guidelines or 2021 OP E&M guidelines are used when determining MDM for TCM?
  3. E

    Wiki TCM Confusion

    For TCM, our Care Manager is under the impression that if a patient is seen within 48 hours of their discharge, we do NOT need to make a phone call prior to the TCM since their appointment is within those 2 business days. Is this accurate or does she still need to call the patient for the...
  4. L

    Wiki TCM code use

    Hello. When billing TCM codes, if the billing provider did NOT see the patient in the ER/hospital (patient was only in the ER, and we did not consult), can my provider who saw the patient in follow up, bill a TCM code?
  5. P

    Wiki Nephrology TCM Coding

    Is a nephrologist allowed to bill TCM services (99495-99496) for patients who are receiving ESRD services (90960-90970) in the same month? Coding book says no but 2020 Final rule reads a little different & states you can now bill the two services. I have included a snip off the Final Rule White...
    • pdaniels18
    • Thread
    • nephrology tcm
    • Replies: 0
    • Forum: E/M
  6. C

    Wiki TCM Documentation

    I am questioning the necessary documentation to bill TCM visits. It is stated that the complexity of medical decision making (moderate or high) must be documented in medical record. Does the provider have to specifically state this in the note or is the CPT Code enough? Any input would be...
  7. K

    Wiki Billing TCM & G0506 Together

    Hello, Looking for some feedback on billing TCM and CCM code G0506 together. It's been brought to our attention that these are denying when billed together. Wondering if a simple -25 modifier would fix or if this isn't allowed. Can't seem to find any clear documentation in the guidelines. Thanks!
  8. K

    Wiki Billing for TCM services during post op period by non-surgeon physician

    I'm trying to find definitive guidance from CMS or in the Federal Regs that indicates a physician can bill for TCM services during the post op period as long as they are not the surgeon. I understand TCM would be covered by the global period for the surgeon. In this case, the patient's PCP is...
  9. J

    Wiki TCM Coding and definition of clinical staff

    I work for a teaching facility and our physicians are wanting to perform transitional care management at the hospitals Outpatient Care Center. Staff at the patient center is employeed by the hospital, while the physicians are employeed by the university. I do not believe the hospital staff fits...
  10. E

    Wiki TCM Visits

    I was wondering if someone can help me with TCM (transition of care visits). We are wanting to do a lab draw the same day but have had it denied before. Do we put a 25 modifier on the visit to get it covered? Any help would be appreciated.
  11. K

    Wiki Billing TCM

    Am I reading correct, we no longer have to hold the TCM codes 99495 and 99496 for 29 days after discharge? They can now be billed at time of service? I hope so;) this would make life much easier!!
  12. N

    Wiki The new date of service rule for billing transitional care management

    Hello all, I was wondering if anyone had any insight on this new ruling for the TCMS. I am aware that the 30 day wait is no longer and we can bill the TCM on the date of the face to face, however, do we bill the office visit and the TCM? Or do we bill the TCM in place of the face to face? Thank...
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