Two TCM encounters in 30 days different DXs

slivingston

Networker
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54
Location
Mechanicville, NY
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We have a patient who was in the hospital and discharged and our provider billed for the TCM visit. However the patient was re-admitted to the hospital during the following 30 days for a different DX. We are conflicted if we can bill for another TCM since it is for a different DX or no? Any advise and if possible guidance to actual documentation to support would be helpful.
 

thomas7331

True Blue
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2,245
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It cannot be reported again if still within 30 days of the first discharge - this is specified in the CPT book. The section guidelines for the TCM codes give this instruction: Only one individual may report these services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within the 30 days.
 

slivingston

Networker
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54
Location
Mechanicville, NY
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Thank you Thomas. I did see that but we were wondering if being that the 2nd hospitalization was for different reasons would it make a difference. Thanks again.
 

teribere

Networker
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27
Location
Fort Worth, TX
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Pt re-admitted within 30 days, not able to bill the first TCM due to timing of re-admit. 2nd discharge and all TCM qualifiers met. Since unable to bill first TCM I think we can bill the 2nd as a TCM? I know some pt's are re-admitted multiple times before a TCM visit can be performed. I have not been lucky finding anything on this specific situation. Your thoughts?
 
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