Transitional Care Management

petroskek

Contributor
Messages
23
Location
Fort Myers, FL
Best answers
0
Good morning,
I am new to family practice coding and would like some assistance. I have a patient that was admitted as inpatient for TIA, then discharged. She was seen within 4 days of discharge. The provider wanted to bill TCM, but when I followed up with the office, no interactive contact was made because, per the nurse, TCM services are only for Medicare and this patient has a commercial BCBS (she is only 57). Obviously this visit is not TCM without that interactive contact, but going forward, should they be doing the contact with major medical patients? Is it billable to commercial insurances, or only Medicare?
As I said, I am new to this and am learning as I go.

Thank you!
 

coding4fun

Guru
Messages
139
Location
High View, WV
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0
Tcm

TCM services are ONLY billed to Medicare. There is a long list of conditions which must be met before you can bill this service out. I know that the one which my practice struggles with is the contact within 2 business day of DC. Then you have to make sure that they are seen within 7 or 14 days. The other thing to consider for the contact is the fact that 2 attempts have to be made and documented and as long as you are seeing this pt within 7 or 14 days you can still bill for the TCM.
 
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