What are the TCM codes?

Transitional care management (TCM) services codes 99495 and 99496 are Current Procedural Terminology (CPT) codes in effect since Jan. 1, 2013. Use these codes for patients discharged from an inpatient setting to the patient’s community setting (e.g., home, assisted living).

Can you bill a TCM code with an E&M?

A7: Yes, for an E/M visit you can bill additional visits other than the one bundled E/M visit in the TCM.

Does Medicare pay for CPT 99496?

Effective January 1, 2013, under the Physician Fee Schedule (PFS) Medicare pays for two CPT codes (99495 and 99496) that are used to report physician or qualifying nonphysician practitioner care management services for a patient following a discharge from a hospital, SNF, or CMHC stay, outpatient observation, or …

What is the CPT code 99496?

Code 99496 has the following requirements: Communication (direct contact, telephone, electronic) with the patient or caregiver within two business days of discharge, Medical decision making of high complexity during the service period, A face-to-face visit within seven days of discharge.

What qualifies as a TCM visit?

Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy.

Who can bill TCM codes?

Nonphysician providers such as physician assistants and nurse practitioners may also bill these codes following the incident-to coding rules. A key point to remember is that only one provider, per patient and per discharge, may bill a TCM code during the 30 days following discharge.

Can you bill an office visit with a TCM?

No. TCM services may be billed by only one individual during the post-discharge period.

Who can bill for TCM services?

The billing provider must be a physician or a qualified non-physician practitioner. Qualified non-physician practitioners are defined as certified nurse-midwives, clinical nurse specialists, nurse practitioners, or physician assistants. 4. Can other services be billed during the 30-day TCM service window?

What does CPT code 99396 mean?

Periodic comprehensive preventive medicine reevaluation
99396. Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years.

When can TCM be billed?

Because the TCM codes represent a 30-day service period, they should be billed no sooner than the 30th day after the patient was discharged – not at the conclusion of the face-to-face visit – and the date of service should be the 30th day after discharge.

What does CPT code 99386 mean?

99386. Initial comprehensive preventive medicine evaluation and management of an individual including an. age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor. reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64. years.

What does CPT code 93000 mean?

routine electrocardiogram
For example, CPT code 93000 denotes a routine electrocardiogram (ECG) with at least 12 leads, including the tracing, interpretation, and report.

When did CPT add the TCM service code?

CPT® added TCM service codes in 2013 to reward medical providers for care that facilitates the transition of a patient with moderate or high complexity medical decision-making (MDM) from an inpatient hospital setting to the patient’s community setting.

When to use the TCM code 99495?

Use TCM code 99495 when the patient requires moderate to high complexity MDM and is evaluated face-to-face between seven and 14 days after discharge. Use TCM code 99496 when the patient requires high complexity care MDM and is evaluated face-to-face within seven days of discharge.

What are the RVUs of a TCM code?

TCM codes reward patient care with work relative value units (RVUs) — a major component of the formula that generates provider payment. Per AAPC’s Work RVU Calculator, 99495 (moderate complexity TCM) has an RVU of 2.11 and 99496 (high complexity TCM) has an RVU of 3.05.

What are the CPT codes for Transitional Care Management?

The two CPT codes used to report TCM are: 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge 99496 – high medical complexity requiring a face-to-face…