Wiki Transitional Care codes denials

[matcpc]

Ok Gang I need help

We have a carrier that does not pay for Transitional Care codes. Once the denial is on the EOB, my doctor wants to do a corrected claim and change the CPT code to E&M. The question I have is

Would this be considered "up-ticking" or "fraud"?

Any help is appreciated
Melissa Taylor, CPC

 

[Pam Warren]

When billing Transitional care management, you must provide one face to face with the physician (less than 14 days post-discharge) that is not billed out, but is bundled into the 30 day care. That face to face may be billed as an E&M visit to the carriers that don't cover TCM.