Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting to reduce potentially preventable readmissions and medical errors during the 30 days following discharge from the acute care setting. Family physicians often manage their patients’ transitional care and use CPT codes for the additional work required to provide support to patients after discharge.
Chronic conditions like dementia, heart disease, and diabetes can often be managed in the community setting, but the interruption in care while the patient is in the transition phase from inpatient to in-home care can put the patient at risk for relapse. It also increases the risk of readmission. This is where TCM is helpful because it ensures the continuity of care during the transition which can dramatically reduce the likelihood of readmission. In essence, the purpose of transitional care management is to focus on facilitating a successful transition.
Following are the two CPT codes that physicians use to report TCM services rendered.
CPT Code 99495: This CPT code is used for moderate medical complexity requiring a face-to-face visit within 14 days of discharge.
CPT Code 99496: This CPT code is used for high medical complexity requiring a face-to-face visit within seven days of discharge.
How Often Can TCM be Billed?
Since it is a temporary agreement, the billing should include a one-time, non-recurring fee, and the care provider should submit the bill after 30 days of discharge. To bill the patient, expectations may be slightly different depending on the CPT codes that apply to the patient. However, the specific requirements must be met to bill for transitional care management during the 30-day period.
Requirements for TCM
- Contact the beneficiary or caregiver within two business days following a discharge via email, telephone, or a face to face visit. Moreover, the attempts to communicate should continue after the initial attempts in the required business days until they get successful.
- Conduct a follow-up visit as a part of the TCM service within 7 or 14 days of discharge.
- Medicine reconciliation and management need to be furnished no later than the date of visit from the care provider.
- Obtain and review discharge information.
- Review the need for diagnostic tests.
- Educate the beneficiary or caregiver.
- If required, establish referrals with community providers.
- If necessary, assist in scheduling follow-up visits.
Components of TCM Service
TCM service period is 30 days. It begins on the date of the discharge from the acute healthcare facility and continues for the next 29 days. The provider is supposed to furnish the following components of TCM service during the 30 day period.
Interactive Contact: Interactive contact must be made by the billing provider or clinical staff within two business days following the discharge.
Non-face-to-face Services: The billing provider must provide non-face-to-face services to the patient, unless not needed.
Face-to-face Visit: The billing provider must furnish one face-to-face visit within certain time frames.
Check Also: What Are the Place of Service Codes
The Goal of TCM
The main objective of TCM is for a provider to oversee the management and coordination of services for the beneficiary, as needed, for all medical conditions and psychosocial needs. Notably, TCM services may be furnished following a patient’s discharge from one of the settings listed below to a community setting:
- Long Term Care Hospital
- Inpatient Acute Care Hospital
- Inpatient Rehabilitation Facility
- Inpatient Psychiatric Hospital
- Skilled Nursing Facility
- Hospital outpatient observation or partial hospitalization
- Partial hospitalization at a Community Mental Health Care Facility
Tips for Billing TCM Services
Here are some TCM billing tips.
- Only 1 provider may report TCM services.
- Providers should report services only once per patient during the transitional care management period
- Transitional care management services providers can report reasonable and necessary E/M services provided to manage the patient’s issues separately.
- Providers can’t bill transitional care management services and services within a post-operative global surgery period because medicare doesn’t pay TCM services if any of the 30-day TCM period falls within a global surgery period for a procedure code billed by the same practitioner.
How to identify patients who require TCM?
Transitional care management requires communication between the acute care setting and outpatient provider. Processes must be followed to notify the patient’s primary care provider of an acute care admission and discharge facility TCM. In the normal practice of acute care, the provider sees the same patients that they discharged in the clinic setting. Identifying the patients eligible for transitional care management should be tailored according to the healthcare system and resources in each community.
How to educate patients about TCM?
The acute care provider can educate the patients who require TCM prior to discharge. During this process, it is also important to inform the patients that they will be contacted within two business days and that a face-to-face visit will be scheduled for them. Also, some organizations schedule the face-to-face visit prior to the patient’s discharge from the acute care facility. Patients should also be made aware that TCM is subject to co-insurance and deductible under Medicare.
What Is a Transitional Care Hospital?
While acute care hospital inpatient receives care to both diagnose and stabilize their condition, and help them recover as quickly as possible, the transitional care hospital provides additional supervised medical attention to further improve the condition of beneficiaries prior to returning home. This type of facility is exceedingly helpful for patients who are not immediately ready to return home. The transitional care hospital also stays connected with a patient’s primary care physician during the days of hospital stay.
TCM is important for managing chronic conditions and ensuring that the beneficiary’s needs are met during the transition period. It is important for a successful transition.