Billing for Transitional Care Management

1. Billing for Transitional Care Management Medical Billers and Coders

2. Many practitioners have difficulty being paid for Transitional Care Management (TCM) services. In many cases, claims submitted for TCM services have not been paid due to several common errors in claim submission. In particular, the practitioner should ensure that the entire 30-day TCM service was furnished, the service began with a qualified discharge from a facility, and that the appropriate date of service is reported on the claim. In this article, we covered basic claim details while billing for transitional care management.

3. Procedure Codes for Transitional Care Management: 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 partial hospitalization. CPT Code 99495 covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision-making of at least moderate complexity and a face-to-face visit within 14 days of discharge. The location of the visit is not specified. The work RVU is 2.11. CPT Code 99496 covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision-making of high complexity and a face-to-face visit within seven days of discharge. The location of the visit is not specified. The work RVU is 3.05.

4. Coding Guidelines • While using codes procedure codes 99495 and 99496 for Transitional Care Management services consider the following coding guidelines: • Medication reconciliation and management should happen no later than the face-to-face visit. • The codes can be used following ‘care from an inpatient hospital setting (including acute hospital, a rehabilitation hospital, long-term acute care hospital), partial hospitalization, observation status in a hospital, or skilled nursing facility/nursing facility.’  • The codes cannot be used with G0181 (home health care plan oversight) or G0182 (hospice care plan oversight) because the services are duplicative. • Billing should occur at the conclusion of the 30-day post-discharge period.

5. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle management services. Our billing services include eligibility verification, medical coding, charge entry, payment posting, denial analysis, account receivables (AR) management, and provider credentialing and enrollment. With our billing services, you can increase your practice collection while staying billing compliant as per payer guidelines. 

6. Email : info@medicalbillersandcoders.com Fax no: 888-316-4566 Toll Free no: 888-357-3226 AddressWilmington, 108 West, 13th street, Wilmington, DE 19801Texas, 539 W. Commerce St #1482 Dallas, TX 75208