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Thread: Transitional Care Management

  1. #1

    Default Transitional Care Management

    AAPC: CPC Promo
    I understand that Medicare is encouraging Transitional Care management. Codes 99495, 99496. This is what the AOA has to say about it: The requirements of the CPT codes are:
    99495, TCM: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; Medical decision-making of at least moderate complexity during the service period; face to face visit within 14 calendar days of discharge.

    99496, TCM: Communication (direct contact, telephone, electronic) with patient and/or caregiver within two business days of discharge; Medical decision-making of high complexity during the service period, face to face visit within seven calendar days of discharge.

    Does anyone have any other info about this? I'm wondering if you have to talk to the patient/caregiver within 2 days of discharge AND see the patient face to face.

    Jennifer

  2. #2
    Join Date
    Apr 2007
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    Dover Seacoast New Hampshire
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    Default

    I haven't yet seen anything from CMS about these codes other than that they're going to be implementing a G-code for TCM without a face-to-face component. CPT has a great description of the guidelines, but I'm still waiting for CMS to either embrace these guidelines or come up with their own. Since the fee schedule lookup still shows 2012B, I don't even know if/how much they're going to cover the TCM and CCCM CPT codes.

    Does anyone else have any information?
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3
    Join Date
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    Kansas City, Missouri
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    TCM requires a couple of things. First: physician or staff must contact the patient within 2 business days of discharge. This can be done by phone, e-mail, or in person. Medication must be reconciled by their first face to face visit. 99495 is to be used for patients with moderate complexity medical decision making, and must be seen face to face in 14 days of discharge. 99496 is to be used for patients with high complexity medical decision making and must be seen face to face within 7 days of discharge. The rule lists several things that physician and or staff can do such as education of the patient and/or caregiver, establishing or re-establishing community and social services, coordinating office appointments with physicians that previously cared for the patient, referrals to social services. They are covering the TCM and it pays about $30 more than a 99214 and requires less physician work.
    Debra Seyfried, MBA, CMPE, CPC
    AHIMA ICD-10 Approved Trainer
    Director of HIM
    University of Kansas Physicians
    913-945-8242

  4. #4

    Default

    In the new CPT book I see it says that the medical complexity is for the service reporting period. Do you think the service reporting period is the time the patient is in the hospital, or just the time between discharge and being seen face to face?

  5. #5
    Join Date
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    The 'service period reporting' is the time following the date of discharge through the next 29 days, according to CPT. So if the patient has moderate or high MDM for services during those days, they'd qualify. Follow your MDM grid from your carrier's audit tool to determine if they meet at least the moderate.
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  6. #6

    Default

    Does anyone know how the contact with the patient for TCM with 2 business days is known/documented since it is a requirement? Or is the 99495/99496 the only thing to bill?
    thanks
    C

  7. #7
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    The contact within in 2 business days should be communication via phone, electronic such as e-mail, or direct face to face. There is no additional code to bill this as proof. It becomes part of your documentation toward the visit.
    Debra Seyfried, MBA, CMPE, CPC
    AHIMA ICD-10 Approved Trainer
    Director of HIM
    University of Kansas Physicians
    913-945-8242

  8. #8

    Default

    RE: TMC Documentation
    I am seeing that it needs to include: Date of patient's discharge, Initial patient contact within 2 days-either phone or email, MDM must be documented-using CMS guidelines, Documented face-to-face encounter. No separate code for the E/M should be billed. That at the end of the 30 days the appropriate TMC code can be billed. Is this correct? Anything new with the CMS G-code?
    Thank you

  9. #9

    Default TCM question

    Would 99495 be appropriate to use as a follow-up to an Emergengy Room visit?

  10. #10
    Join Date
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    Hi, I'm attaching a guide I put together for our Internal and Family practice groups to assist with billing understanding and documentation criteria in our EHR for these codes. I hope it's helpful. I think it will clear up a lot of confusion.


    Also, read Debra Seyfried, MBA, CMPE, CPC's article about TCM at
    http://blogs.aafp.org/fpm/gettingpai..._new_codes_for

    Have a good weekend, everyone. Pam
    Attached Files Attached Files
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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