Wiki Transition Care Management

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bdye

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Since these are new codes this year, 99495 and 99496, we are looking at the necessary elements - Moderate complexity and High complexity medical decision making. It states in the description, that the MDM is defined by the E/M Services Guidelines. It also states "the MDM over the service period reported, is used to define the MDM of the TCM (Transitioanl Care Management). I was wondering how the rest of you are intrepreting this.
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The workflow that we've considered thus far is that we will identify if the patient is eligible when the provider will calculate the level of MDM at the post-discharge visit (our providers know E&M very well). On a go-forward basis, if the patient significantly requires intensive nurse care manager resources, such that they would meet a higher level of MDM (i.e. non-compliant, exacerbation of illness, medication reconciliation issues, etc.) then we'd evaluate if the patient would meet the high MDM prior to charge drop. Our providers have determined that they, not the nurse care managers will determine level of MDM, which I absolutely agree with.
 
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