Transition Care Mgmt

Worxs43

Networker
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34
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Hello :)

Does this qualify for TCM to bill for pcp? (99495,99496)
The patient had a planned laparoscopic surgery in which they were admitted and stayed overnight to make sure everything was fine.
Usually when I handle TCM visits it's when the patient went to the emergency department for emergent issues they were having, then consulting provider made
decision for surgery to happen within same day. Is there any difference when the surgery is planned along with just keeping the patient overnight for assurance?
 

brucep

New
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6
Location
Rochester, NY
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Whether the surgery was planned or unplanned doesn't matter in TCM visits. What matters is that you meet the level of MDM (at least moderate complexity for 99495 or high (99496) during the service period), that the patient is transitioning from a hospital setting other than the ED or from a skilled nursing/nursing facility setting to their home or assisted living, and that you meet all the other criteria for the codes. This includes communication with the patient and/or caregiver within 2 business days of discharge and an f2f visit within 14 calendar days of discharge (99495) or 7 calendar days of discharge (99496).
 

Worxs43

Networker
Messages
34
Best answers
0
Whether the surgery was planned or unplanned doesn't matter in TCM visits. What matters is that you meet the level of MDM (at least moderate complexity for 99495 or high (99496) during the service period), that the patient is transitioning from a hospital setting other than the ED or from a skilled nursing/nursing facility setting to their home or assisted living, and that you meet all the other criteria for the codes. This includes communication with the patient and/or caregiver within 2 business days of discharge and an f2f visit within 14 calendar days of discharge (99495) or 7 calendar days of discharge (99496).
Thank you
 
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