Transitional Care Management

amberhoyt

Guest
Messages
5
Location
Vestaburg, MI
Best answers
0
There is a debate between myself and the providers in my practice. If a patient is discharged from the hospital and a TCM call is completed prior to the patients in-person visit; but the patient comes into the office with a condition which is not related to the hospital stay, should we bill a TCM on the originally scheduled day or should we bill for a regular E/M visit and bill for the TCM at a later date.

An example would be there is a patient who is very orthostatic and needs IV Fluids while being seen for his TCM. The provider believes that the patient should be billed for E/M and the IV Hydration and then come back the next day for Transition of Care. I am believing that this can be included in the TCM as it includes 1 E/M visit. Can someone please confirm for me? I dont want to do anything fraudulent.
 
Messages
1
Location
Wichita Falls, TX
Best answers
0
Did you have any response to your scenario?
I have one that is similar where the provider is seeing the patient for TCM but an acute problem focused issue is addressed that is not related to the diagnosis of the TCM visit. Therefore, wanting to bill the TCM and E/M visit on the same date of service. I'm not finding any guidelines stating that this cannot be coded. Example would be 99495, 99214-25 modifier
 
Messages
385
Best answers
0
CPT is clear that the first face-to-face visit is part of the TCM service and not reported separately. Also, the care provided during the TCM is supposed to be of moderate to high complexity. To get an idea of the kind of physician work that is included in TCM, the TCM RVUs are somewhere between 99204 and 99205 based on the nature of the patient who requires TCM likely having new problems, new medications, and risk of readmission. The physician providing TCM is responsible for overseeing all of the patient's health care needs during the period, not just those deemed related to the reason for hospitalization.

This part is just my opinion but to bring the patient in the next day to create a billable service could be seen as an abusive practice. This is similar to what the NCCI manual states, "Physicians shall not inconvenience beneficiaries nor increase risks to beneficiaries by performing services on different dates of service to avoid MUE or NCCI PTP edits."

Cindy
 
Top