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  • How much more can you get in reimbursement by choosing TCM codes? Get The Difference in Your Pocket

Transitional Care Management (TCM) provides a win/win situation for both physicians and patients. By focusing on the transition of patients’ care from the hospital to home, TCM services allows you to prevent re-admission, improve patient satisfaction and practice revenue.

How TCM Improves Patient Service

When practices adhere to the TCM protocol, patients are guaranteed essential post discharge services in a timely manner. Requirements to visit high complexity patients within 7 days and moderate complexity patients within 14 days, places a checkpoint for both clinicians and patients to take action prior to potential re-hospitalization.

How TCM Improves Your Revenue

With recent changes from Medicare and Medicaid, providers are now receiving reimbursement for previously unpaid services involving discharge-specific follow up care for patients.

Two new CPT codes will be used to pay for services:

  • CPT Code 99495 covers communication with the patient or caregiver within two business days of discharge and involves medical decision making of at least moderate complexity and a face-to-face visit (regardless of location) within 14 calendar days of discharge.
    • RVU: 3.12; Payment: $111.97
  • CPT Code 99496 covers communication with the patient or caregiver within 2 business days of discharge and involves medical decision making of high complexity with a face-to-face visit (regardless of location) within seven calendar days of discharge.
    • RVU: 4.52; Payment: $162.22
Payment Differences for Codes with Same Medical Complexity
Moderate Complexity High Complexity
TCM 99495 99214 TCM 99496 99215
Type of CPT Code TCM code Outpatient office visit TCM Code Outpatient office visit
Duration Requirement Face-to-face within 14 days of discharge 25 minutes spent face-to-face Face-to-face within 7 days of discharge 40 minutes spent face-to-face
Work RVU 3.12 2.22 4.52 3.14
Reimbursement $111.97 $79.67 $162.22 $112.69

 

The 30-day TCM period begins on the date the patient was discharged from the inpatient hospital, and continues for the next 29 calendar days.

How DocCharge Incorporates TCM Requirements:

Real Time Update: Office will be notified of discharge in real time for established patients, so that clinical staff may effectively contact patient within the 2 business day requirements.
Review & Prepare: Physicians and/or non practicing physician (NPP) will have access to discharge diagnosis and relevant medication information from anywhere within timely manner.

Our DocCharge Gift to You:

The number one reason most TCM claims get denied is due to preventable mistakes in documenting, and lack of a team’s awareness regarding timeline requirements.

To find out more about how you can prevent this, fill out the form to download our free question guide.