Question Transitional Care management

Gator

Networker
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29
Location
Rapid City, South Dakota
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We are a family practice office that frequently will see our patients after a hospital stay. We have always billed just a regular E&M but, are wondering if we should be billing transitional care management. In what situations, if any, are we able to do this? For example, we follow Jon Doe for chronic conditions management. Over the weekend he is admitted to the hospital for an unrelated condition. We receive fax notification from the hospital that our patient was admitted with a subsequent surgery and discharged today. We did not round or see Jon in the hospital. We do not see in the documentation an order to follow up with us, primary care. Do we contact the patient?
I have absolutely no knowledge of Transitional Care Management so any education will be appreciated.
Thanks.
 

TThivierge

Guru
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200
Location
Lithonia, GA
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Hi Gator ! :)
I have dealt with in coding this Transitional Care mgnt. CPT 99495- 99496. Provider must put in note something to effect treatment check up for patient because inpatient a few days ago at such and such hospital or last week on this illness. I was told had up to 2 weeks after inpatient discharge date to follow up with patient. Yes patient should be called 2 days after get home(documented somewhere ) and their family doctor called for upcoming appointment to follow up with family doctor. Yes one of the TCM CPT was used plus Ev. Mgt code on same visit however provider must document separate reasons why patient being treated for each CPT session. Patient seen for TCM 99495 and update on other chronic conditions used CPT 99213. We put modifier 25 on CPT 99213 . Or let us say patient come for annual physical document data use proper CPT add modifier 25 and TCM 99495. Documentation is the key!

CPT Code 99495 covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge. The location of the visit is not specified.

Hope this data helps you😊
Lady T
 
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