Wiki TCM

[KoBee]

Starting to help code TCM but am i getting confused on the requirements. For TCM do you have to have all the requirements or some to count as TCM within the medical record.

Requirements:

• Date of discharge in record
• Date interactive contact was made with the patient and/or caregiver;
• within 2days of discharge
• Date of the face-to-face visit; within 7 or 14 calendar days of discharge
• Complexity of MDM.

Thank you

 

[jbhuju]

yes the above are required elements for TCM.

 

[dartbryant]

The contact with the patient or caregiver, would the hospital employee calling to make the follow up appointment count as the caregiver?

 

[Elliewl]

Per the Medicare guidelines, clinical staff can make the interactive contact with the patient and/or caregiver, however it would need to be clinical staff under your physician/ NPPs direction. In my experience working for a physician group, a hospital employee calling to make an appointment would not meet this requirement. https://www.cms.gov/files/document/mln908628-transitional-care-management-services.pdf

 

[medicalauditor]

The contact with the patient or caregiver, would the hospital employee calling to make the follow up appointment count as the caregiver?

The guidelines state: "The interactive contact must be performed by clinical staff who can address patient status and needs beyond scheduling follow-up care." In other words, a call just to make a follow-up appointment does not count as an interactive contact for TCM. The person calling is not the caregiver, the caregiver is the patient's caregiver who is being called.

 

[medicalauditor]

Starting to help code TCM but am i getting confused on the requirements. For TCM do you have to have all the requirements or some to count as TCM within the medical record.

Requirements:

• Date of discharge in record
• Date interactive contact was made with the patient and/or caregiver;
• within 2days of discharge
• Date of the face-to-face visit; within 7 or 14 calendar days of discharge
• Complexity of MDM.

Thank you

All of these are required elements of TCM, but this is not all. One needs to understand the purpose of TCM, and why a provider is paid for this service at a much higher rate than office E/M. Providers are paid for transitional care services during the 30-day period that begins when a physician discharges a patient from an inpatient stay and continues for the next 29 days. These services help eligible patients transition back to a community setting after a stay at certain facility types. It is important to note the key words here. Not everyone who gets discharged from a hospital would need transitional care management, so the medical record must clearly show that the patient's status and medical condition was such that they needed ongoing care from the provider in order to transition back to the home or community. Medical decision-making is not limited just to the visit after discharge, it is for the 30-day period, and just having a follow-up visit with the provider within 7-14 days in itself does not mean that TCM can be billed. For example, if a patient is stable or the condition is resolved, the f/up appt is just a routine appt in which the provider notes that the patient is doing well, and there's no active management for the 30-day period, it does not count as TCM. Hope this helps.