Hi, ED does not count unless they were admitted into observation and stayed in the ED due to lack of rooms elsewhere in the hospital.Hi All, I am wondering if TCM is billable after ED visit? It indicates in guidelines after inpt/observation but doesn't mention ED so I'm thinking NO but wanted to see if others are reading this differently. Any insights would be appreciated.
Thank you very much!!Hi, ED does not count unless they were admitted into observation and stayed in the ED due to lack of rooms elsewhere in the hospital.
- Discharge from any of the following:
- Inpatient acute care hospital
- Long-term acute care hospital
- Skilled nursing facility/nursing facility
- Inpatient rehabilitation facility
- Hospital observation status or partial hospitalization
- CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge
- CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge
Requirements and Components for TCM
- Contact the beneficiary or caregiver within two business days following a discharge. The contact may be via telephone, email, or a face-to-face visit. Attempts to communicate should continue after the first two attempts in the required business days until successful.
- Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision making involved. The face-to-face visit is part of the TCM service and should not be reported separately.
- Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.
- Obtain and review discharge information.
- Review the need for diagnostic tests/treatments and/or follow up on pending diagnostic tests/treatments.
- Educate the beneficiary, family member, caregiver, and/or guardian.
- Establish or re-establish referrals with community providers and services, if necessary.
- Assist in scheduling follow-up visits with providers and services, if necessary.