billing TCM codes
the TCM codes have to be billed on the 30th day after discharge even if this date lands on a weekend that is the date to bill. I have billed over 70 of these TCM and have gotten paid on 62 of them - BCBS will pay for these.
Only 1 TCM can be billed every 30 days-any specialty can bill this- so first one in with the claim will get the payment anyone after this will have to charge a regular office visit.
Criteria for the TCM is
this must be in doctors dictation)
Medical Decision Making must be at least Moderate complexity
patient must be contacted within 2 business days of discharge(via phone,electronics or caregiver
patient must be seen face to face within 7 calendar days of discharge to bill a 99496(high complexity)
patient must be seen face to face within 14 calendar days of discharge to bill a 99495(moderate complexity)
if patient is readmitted before the 30 days the first face to face will be billed as regular
office visit and then the TCM will be billed 30 days after the second discharge
I have created a spreadsheet that I keep all this information on and view regularly so can keep track of when I need to bill the TCM. This has been a trial and error thing for me. I have even had Nurse Practitioners bill this and have gotten them paid also.