ED Coding and Reimbursement Alert

Just Because It Doesn't Say You Can't, Doesn't Mean that You ShouldCMS, like CPT®, did not explicitly prohibit emergency physician use of transition of care codes. However, it seems unlikely that emergency physicians will meet the requirements to report these codes. (Editor's note: See the ED Coding & Reimbursement Alert, November issue (Vol. 15, No. 11) for a complete explanation of the new code sets.) The skinny: The new codes capture the non-face-to-face time physicians, non-physician practitioners and other clinical staff spends in the 30 days following a patient's release from a hospital or skilled nursing facility (SNF). Originally labeled a G-code in the proposed fee schedule, TCM services are now CPT® codes 99495-99496.In the final rule CMS states, "In conjunction with adopting the AMA CPT® TCM, we accept the recommendation to allow reporting of emergency department visits by [qualified primary care physicians] when also billing the CPT® TCM codes." [...]