TCM template

What should a TCM encounter template look like in case medicare does an audit?

Should I create a separate TCM form that documents

Discharged Patient: _______-
Date of Discharge: ________

Note:
a) contact made in 48 hours by staff to resident to check on resident and needs noted.
b) 7 day f/u enocunter date ____ Patient seen. Dischage summary reviewed and medicaiton list reconciled with appropriate corrections if needed. Followup testing and labs arranged. MDM documented (no physical, but just the assessment and plan showing the MDM level).

Billing: 99496 99495

Dr. XXXXX

Can this suffice as the TCM form as proof of delivered care? Anything else you'd add in a template.

re: TCM template

I suggest going through the CPT® list of elements that may be part of TCM, and adding them to your template.

Not all need to be done for each patient.

Also, document the level of complexity--although that will be in the first E/M.