Wiki Transitional Care Management (TCM)


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Please help..
A patient was discharged with complex care from the hospital and due for physical exam. The visit was scheduled within 2 days of discharge. Can we bill the preventive visit AND the transitional care service (with -25 modifier) on the same day?


The transitional care code already includes the one required face-to-face visit so it wouldn't be appropriate to bill that visit as an E&M code on the same date. But if there are any additional medically necessary visits within the 30-day transitional care period, those can be billed. Here's a link to a good Medicare publication for TCM guidelines:
I responded without noticing that your visit was preventive, which is a little different situation that isn't addressed specifically in the Medicare article. I think if you're documentation supports two distinct services that meet both the definition of the management required for the TCM and the full annual physical, you could support billing both of the codes.