Wiki Transitional Care Management - nursing facility

[kelam]

Can you bill Transitional Care Managment when going from a hosptial to a nursing facility or do you have to wait until the patient comes out of the nursing facility?

 

[Pam Warren]

According to CPT, patient has to be discharged to their "community setting", i.e. home, domiciliary, rest home (not nursing home) or assisted living. These are all locations without a medical presence, such as you'd find in a nursing home or SNF.

 

[LadyJ317]

Acute Hospital definition

Pam,

I have a question and I posted here due to there is less traffic for my question. We have ran into an issue with patients being seen in the ER and the doctors billing a TCM after they have been released. In the CPT book it states transitions in care from an inpatient hospital setting) including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hosptial, or skilled nursing facility/nursing facility.

So I am just trying to understand the meaning of acute hospital and observation because you can be admitted and discharged on the same day for both.



Jennifer
CPC

 

[Pam Warren]

I think this was addressed in the other huge thread, but the ED does not meet the criteria for an admission or observation service from which you can subsequently bill the TCM. Admission to the ED is not the same as admission to either IP or OSV.