tci Medicare Compliance & Reimbursement - 2013 Issue 16

Reimbursement: Report TCM Codes Correctly To Keep Income Flowing

Note these differences between Medicare and CPT® for coding transitional care management. There are some significant differences in the requirements for reporting the transitional care management (TCM) codes to Medicare and to CMS. The latest advice came from a recent CMS Rural Health Open Door Forum call, which offered the following advice. Starting point: CPT® 2013 includes two new TCM codes: 99495 – Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service...

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