Wiki Transitional Care

[Laura Ortega]

Transitional Care is not time based, however, with several different insurances that do not allow TCM billing; is it appropriate for a provider to add a time notation since these visits can be very lengthy and they are "potentially" needing to change to an E/M visit by the coder? I have searched CMS and several different sites to verify that this is allowed or prohibited but have not found any information on the subject.

 

[jojokat]

Since the visit is being converted to E/M visit, if the provider documents time spent then the visit can be billed based on time alone per the 2021 E/M guidelines. Just make sure that the provider knows to fully document everything that would normally be documented for the TCM visit as well as the time to fully support the visit.

 

[AmandaBriggs]

Also, remember that the time for an E/M service is time personally spent by the provider, not support staff. It also needs to be face-to-face (in person or virtual) with the patient.