# Transition in Care coding



## debi (Dec 14, 2015)

Has anyone heard that the codes 99496 and 99495 can be submitted without a 30 day hold as of January 1, 2016?

My medical director insists this is true and I have not been able to track down information on this issue.

Thank you


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## mhstrauss (Dec 14, 2015)

debi said:


> Has anyone heard that the codes 99496 and 99495 can be submitted without a 30 day hold as of January 1, 2016?
> 
> My medical director insists this is true and I have not been able to track down information on this issue.
> 
> Thank you



I do remember reading an article about this...trying to remember where. I'm thinking it was in a fairly recent Part B News. I'll try to track it down.

See #3 here...will keep looking for a CMS reference.

http://gettingpaid.kareo.com/gettingpaid/2015/12/9-changes-coming-to-medical-billing-in-2016/


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## stephsaylor30@yahoo.com (Jan 3, 2016)

*Cpc*

I read the same thing in Part B news.  Here's my question.  If you report 99495 or 99496 on the day you see the patient for their hospital follow up visit, but end up readmitting the patient before the 30 day TCM period is up what happens?


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## Pam Brooks (Jan 4, 2016)

I had heard that from a colleague, but haven't seen it in writing, despite a significant search.  If anyone happens to stumble across it, can you post the link?  Thanks.


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## HOLATIGGY (Jan 8, 2016)

*Tcm documentation*

Here is the only documentation I have found on the CMS website. Here is the link https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R217BP.pdf
Notice there is a line that states: The TCM visit is billed on the day that the TCM visit takes place, and only one TCM visit may be paid per beneficiary for services furnished during that 30 day post-discharge period.
110.4 - Transitional Care Management (TCM) Services
(Rev. 217, Issued: 12-31-15, Effective: 02-01-16, Implementation: 02-01-16)
Effective January 1, 2013, RHCs and FQHCs can bill for qualified TCM services furnished by a RHC or FQHC practitioner. TCM services must be furnished within 30 days of the date of the patient’s discharge from a hospital (including outpatient observation or partial hospitalization), SNF, or community mental health center.
Communication (direct contact, telephone, or electronic) with the patient or caregiver must commence within 2 business days of discharge, and a face-to-face visit must occur within 14 days of discharge for moderate complexity decision making (CPT code 99495), or within 7 days of discharge for high complexity decision making (CPT code 99496). The TCM visit is billed on the day that the TCM visit takes place, and only one TCM visit may be paid per beneficiary for services furnished during that 30 day post-discharge period. The TCM visit is subject to applicable copayments and deductibles.
TCM services can be billed as a stand-alone visit if it is the only medical service provided on that day with a RHC or FQHC practitioner and it meets the TCM billing requirements. If it is furnished on the same day as another visit, only one visit can be billed.


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## Pam Brooks (Jan 8, 2016)

These two sentences make me wonder:"RHCs and FQHCs can bill for qualified TCM services furnished by a RHC or FQHC practitioner.TCM services can be billed as a stand-alone visit if it is the only medical service provided on that day with a RHC or FQHC practitioner and it meets the TCM billing requirements."This is specifically for Rural Health Centers and Federally Qualified Health Care practitioners. Does this mean that TCM billing on the day of the TCM visit is only for these providers, and not for private practitioners?I'm not changing anything yet in terms of our DOS unless I get further clarification.  Anyone?


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## SUEV (Jan 8, 2016)

*Federal Register*

As far as I've found, the information regarding billing TCMs with the date of the face-to-face service has only been listed in the Federal Register. On page 37 of the pdf printout, they state they are adopting recommendations to allow date of service and that they "will revise the existing subregulatory guidance" but I haven't been able to find anything that shows it's been done yet.
 I tried adding the link to the document but the forum's not allowing the complete address.  Try searching for the Federal Register, Vol 80, No 220 Part II dated November 16, 2015.


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## jchronaberry (Jan 8, 2016)

Yes it is true I got it from the webinar from Elizabeth Woodcock as well on 1/6/16.  My question is what happens if your patient gets readmitted do we still get paid for the trans care visit?


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## kathymoon (Jan 11, 2016)

I received the information from a coder who attended Ms. Woodcocks' webinar.  So I went into research mode and found nothing.  I emailed Ms. Woodcocks and she referred me to the Federal Register.  This was her response:

"[CMS] Response: We will take these comments into consideration in the development of potential proposals for future PFS rulemaking. We will develop subregulatory guidance clarifying the intersection of fax transmission and CEHRT for purposes of CCM billing Regarding TCM services, we are adopting the commenters' suggestions that the required date of service reported on the claim be the date of the face-to-face visit, and to allow (but not require) submission of the claim when the face-to-face visit is completed, consistent with current policy governing the reporting of global surgery and other bundles of services under the PFS. We will revise the existing subregulatory guidance for TCM services accordingly."

This is the link she forwarded to me.

https://www.federalregister.gov/art...ysician-fee-schedule-and-other-revisions#h-79


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## stephsaylor30@yahoo.com (Aug 16, 2016)

*TCM Date of service*

I'm still holding my tcm claims until the 30th day post discharge to avoid any potential confusion should the patient be readmitted or expire before the 30 day tcm period is up.  I was advised to do this by a speaker from CGS at an AAPC meeting as well as fellow AAPC members.  Thoughts?  Anyone else still hold their claims?   The other thing about billing tcm claims on the date of the face to face visit is if the hospital charges have not been billed yet, the tcm service will be denied (since there is no hospital dc to connect it to).  Curious about what everyone else is doing.


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