- 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
| 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.