transition of care

I have a patient that had shoulder surgery and was discharged to a SNF. During the transition period, she was admitted to another hospital with pneumonia. Upon discharge she was re-admitted to the same SNF. Can I bill for another trasition of care siince it was a different facility and diagnosis even though she is still in the first transition of care

re: transition of care

These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility, to the patient’s community setting (home, domiciliary, rest home, or assisted living). Transitional care management commences upon the date of discharge and continues for the next 29 days.
These codes are when discharging to community services from SNF, not to a SNF.

re: transition of care

The TCM codes may not be billed when patients are discharged to a SNF. For patients in SNFs there are E/M codes for initial, subsequent, discharge care, and the visit for the annual facility assessment,specifically CPT® codes 99304-99318. These codes may be billed for SNF beneficiaries for the care management services they receive in the period after discharge from an acute care hospital.
However, when SNF patients are discharged from the SNF to the community or to a nursing facility, the physician or practitioner who furnishes TCM services can use the CPT® TCM codes to bill for those services.

re: transition of care

Have you read the Codapedia article or CMS FAQ or the editorial comments in the CPT® book? All provide good information about these codes. FAQ attached to article.

http://codapedia.com/article_598_Transitional-Care-Management-Services-TCM-UPDATE.cfm