Wiki Transition of care

[niehaus_danielle@yahoo.com]

Scenario,

This is a transition of care from ER pt was in a mva. Pt also tells the provider he has been dealing with a cold so the provider addresses that and writes him a prescription for the cold symptoms. Can we bill for Transition of care
(99495-99496) and an additional office visit charge for addressing the cold in the same visit???

 

[Pam Warren]

You cannot bill TCM following an ED visit. For the purpose of TCM, ?discharge? refers to a discharge from an inpatient setting such as an acute care hospital, rehabilitation hospital, long-term acute hospital, or skilled nursing facility. It also refers to discharge from observation status in a hospital, or from a partial hospital program, which is a program for mental health and substance abuse disorders that involves spending the day at the treatment center and the night at home. No other discharges are allowed under the guidelines. Emergency department discharges are excluded, as well as discharges from assisted living facilities.

 

[niehaus_danielle@yahoo.com]

If the person was inpatient at the hospital and the next day went to his primary care physicians office (us) for fallow up ,could we bill transition of care as well as the e/m level for addressing a cold in addition to the problems caused by the mva?

 

[cheermom68]

The TCM code would have to be billed with a DOS of the 30th day post discharge. You should have your provider do two separate progress notes, one for the E&M and one for the TCM and then there shouldn't be a problem with billing because they will have two different dates of service.

 

[niehaus_danielle@yahoo.com]

Thank you so much!