We recently attended a webinar, where the host stated that TCM codes 99495 and 99496 could not be billed if the patient is readmitted to the hospital within the 29 days the TCM covers from the original discharge. We have reviewed the information in the 2002 CPT Professional Edition on pages 71 and 72 and do not see that specifically stated.
The second paragraph on page 72 reads, Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within the 30 days.
This paragraph references subsequent discharge(s) with the 30 days so I would assume there is a hospital admission at some point. We understand, we are not to bill another TCM for the second discharge. We are looking to the AMA for further clarification since the guideline rule does not state if the patient is readmitted within the 29 days, bill only an outpatient EM code for the face-to-face visit.
That is correct, Transitional care management services (TCM) begins on the date of discharge and continues for the next 29 days. As you mentioned, the AMA states. “Only one individual may report the services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within 30 days. “In addition, part of the TCM service is the first face-to-face visit, which is included in the TCM service and not separately reported. The guidelines also state. “Additional E/M services provided on subsequent dates after the first face-to-face visit may be reported separately.”There is extensive work that goes into transitional care management services (TCM), it would not be expected or payable to report either of these services more than once in the 30-day period. When reporting 99495, the face-to-face visit is within 14 calendar days of discharge.
Communicating (with the patient, family members, guardian or caretaker, or other professionals) regarding what should be included in the patient’s care. * Medication management.* Assisting with locating community and health resources as well as any other care.* Communication with other services needed such as home health agencies and any other services needed. *Patient and/or family or caretaker- Self-management education to support independent living.99495 and 99496 also include Nonface-to-face services provided during TCM such as the following.*Review discharge summary and other care documents* Follow up or schedule diagnostic tests and additional treatments* Interaction with other health professionals assuming care of the patient* Any additional education for patient, family, guardian, and/or caregiver* Establishing other needed community resources*Scheduling any required follow-up with community providers and services.