I am not sure if everyone else is confused with these new codes as I am but I am hoping someone can help me. Is an E/M allowed on the same day you bill either 99495 or 99496? Does it have to be for a different problem?
You could look at the cci edits and see if these can be billed on the same dos.
Here is some information on the code.......
Transitional care services cover a 30 day period that starts from the day of discharge. It is not an e/m code. It's more of a coordination of care code and management of services needed.
Transitional care management commences upon the date of discharge and continues for the next 29 days.
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Transitional care management (TCM) is comprised of one face-to-face visit within the specified time frames, in combination with non-face-to-face services that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his or her direction. Below are the two new CPT TCM codes and their related requirements:
99495 Transitional Care Management Services (Moderate Complexity):
o Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days post-discharge.
o Medical decision making of at least moderate complexity during the service period.
o Face-to-face visit, within 14 calendar days post-discharge.
99496 Transitional Care Management Services (High Complexity):
o Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days post-discharge.
o Medical decision making of high complexity during the service period.
o Face-to-face visit, within 7 calendar days post-discharge.
Reminder: “Some codes are mutually exclusive with the transitional care management codes, so you'll have to look at CCI to look at additional services that may be bundled,” said Jim Bavoso of NGS Medicare during a Feb. 7, 2013, “Ask the Contractor” conference call.
Factor In These New FAQ Pointers
During the March 12 CMS forum, Howe emphasized the following areas:
When determining which place of service (POS) code to use on your TCM claim, you should use the location that “required the face-to-face visit.”
The 30-day TCM period begins on the date of discharge and continues for the next 29 days. Your date of service should be the thirtieth day of care — not the first, Howe said during the CMS call.
CMS will reject any claims with dates of service prior to Jan. 30, 2013, because the codes became effective on Jan. 1 and only cover 30-day periods.
You can report TCM codes for both new and established patients, Howe said, which is a departure from CPT® rules. “CPT® guidance suggests that the codes are only for established patients, but for Medicare purposes, they can be reported for new patients as well,” he said.
If 30 days pass between discharge and the initial communication with the TCM practitioner, you cannot report TCM codes, Howe said during the call.
Medicare will pay only the first TCM claim received per beneficiary in one 30-day period beginning on the date of discharge, so if more than one practitioner reports the code for the same patient, only the doctor whose claim is received first will get paid.
If the patient dies before the thirtieth day of TCM, you cannot report the TCM codes because they cover a full 30 days. Instead, you'd report the appropriate E/M code.
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My office is struggling with these codes as well. Eventually we will come to a meeting of the minds on when to bill or not bill these.