I am looking for any information regarding a real-life situation when either of these codes would be used. Would these pertain to PCPs for physical health or mental health are providers?
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Tag Archives: Transitional
Is Transitional Care Management (TCM) appropriate for this patient?
Hello. Hoping someone can help with my TCM question.
A TCM service was started for a patient who was in the hospital and worked up for chest pain. All diagnostic testing was negative. A 2 day outreach, medication reconciliation and a face-to-face visit with the physician was completed. The physician addressed the patient’s resolved chest pain, stable hypertension and stable hyperlipidemia. He ordered the nurse to follow up with the patient in a week to get an updated status on the patient’s condition. Wants to make sure the patient is not having any chest pain symptoms that may prompt the patient to go back to the hospital. The RN called the patient who was feeling fine and reported no chest pain symptoms.
Is it appropriate to report a TCM service for this patient considering clinical non-face-to-face services only included a follow-up phone call to the patient to address current health status?
Thank you!!
Transitional Care Management
Good morning,
I am new to family practice coding and would like some assistance. I have a patient that was admitted as inpatient for TIA, then discharged. She was seen within 4 days of discharge. The provider wanted to bill TCM, but when I followed up with the office, no interactive contact was made because, per the nurse, TCM services are only for Medicare and this patient has a commercial BCBS (she is only 57). Obviously this visit is not TCM without that interactive contact, but going forward, should they be doing the contact with major medical patients? Is it billable to commercial insurances, or only Medicare?
As I said, I am new to this and am learning as I go.
I am new to family practice coding and would like some assistance. I have a patient that was admitted as inpatient for TIA, then discharged. She was seen within 4 days of discharge. The provider wanted to bill TCM, but when I followed up with the office, no interactive contact was made because, per the nurse, TCM services are only for Medicare and this patient has a commercial BCBS (she is only 57). Obviously this visit is not TCM without that interactive contact, but going forward, should they be doing the contact with major medical patients? Is it billable to commercial insurances, or only Medicare?
As I said, I am new to this and am learning as I go.
Thank you!
Billing TCM (Transitional Care Management)
Good afternoon all,
We have been having a hard time definitively telling our providers whether an Exam and RoS need to be documented, and how extensive they need to be, in order to bill for Transitional Care Management. Is there anyone who could help shed some light on this subject? I have been looking through the guidelines, on CMS, MLN, AAPC and I cant find anything that touches on the subject of exams and RoS, it all goes over MDM.
Thank you,
Jessica Wegner, CPC-A
Transitional Care Management & Evaluation and Managment code SAME DAY?
Hello, just curious to see if other primary care practices are seeing Transitional Care Management Codes being used the same day as an Eval & Management code? Say they address something separate from the hospitalization, and the documentation supports, I don’t see anything that says otherwise that the provider can’t charge out a separate E&M. Thanks!
Transitional Care Management CPT 99495-99496
We have a debate going at work – According to the CMS guidelines for TCM – If a patient’s condition has resolved by discharge would you still use the same diagnosis code for when the patient was in the hospital?
Transitional Care Management Codes Require 3 Elements
Coding 99495 and 99496 takes more effort than deciding whether the patient is seen 7 vs. 14 days after discharge. The CPT® guidelines for transitional care management (TCM) codes 99495 and 99496 seem straightforward, initially, but the details are trickier than is commonly recognized. Here’s what you need to know to report these services appropriately. […]
AAPC Knowledge Center
Transitional Care Management Initial Communication
The transitional care management initial communication requirement stipulates that to report TCM services (CPT® 99495 and 99496), “An interactive contact must be made with the beneficiary and/or caregiver, as appropriate, within 2 business days following the beneficiary’s discharge to the community setting. The contact may be via telephone, email, or face-to-face.” Source: Medicare Learning Network, “Transitional […]
AAPC Knowledge Center
Transitional Care Units?
Looking for information on how Transitional Care Units (within facilities) are reimbursed. My understanding is they are paid a per diem, but is this correct? What happens if a patient needs care that the TCU cannot provide. For example–can a TCU discharge a patient to a Wound Center for care on a particular day, and would that Wound Center be reimbursed? What if the Wound Center was part of a different facility?
Are there any inclusion/exclusion/carve out lists for TCUs that we should reference–not finding much via google or on CMS.gov.
Thank you!
Jennie
Transitional Care codes denials
Ok Gang I need help
We have a carrier that does not pay for Transitional Care codes. Once the denial is on the EOB, my doctor wants to do a corrected claim and change the CPT code to E&M. The question I have is
Would this be considered "up-ticking" or "fraud"?
Any help is appreciated
Melissa Taylor, CPC