Can A Physician Report A Telephone Service If Done Within 2 Weeks After Face To Face Visit

Transitional Intendance Management Services: New Codes, New Requirements

Two new codes will help you get paid for managing a patient's transition from the inpatient to outpatient setting, but they come with new expectations.

Fam Pract Manag. 2013 May-June;20(three):12-17.

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Commodity Sections

Introduction
Defining "discharge"
Initial contact required inside two business days
The face up-to-confront visit: complication and timing
Components of TCM
When to submit the TCM merits, and when to bill for other services
What practise these codes pay?
Who tin can bill these codes?
How exercise you quickly discover out that the patient was discharged?
How exercise yous get the information you need?
Effigy out your office workflow
References

This article was published online alee of print on April 11, 2013.

On Jan. 1, 2013, the much anticipated transitional care management (TCM) codes arrived. These codes can be institute in the evaluation and management (East/Thou) section of the 2013 CPT manual.¹ They have potential benefits not just for you, the physician, but also for your patients and your local hospitals.

Transitional care management addresses that period of handoff between an acute care setting and the outpatient setting. Normally the patient has just experienced a medical crisis, had a change in therapy, or received one or more new diagnoses and is now expected to follow upward with his or her primary care physician, as well as previous or new specialists. The take a chance for medical error and readmission during this period is high, especially amid older patients. The xxx-solar day readmission charge per unit for Medicare patients with primarily medical admissions was xvi pct in 2010.² Many of these readmissions are felt to be preventable with amend primary care follow-upward after belch, which the TCM codes were introduced to promote.

Seeing a patient through this transition is often time-consuming. The new codes recognize the extra work with higher reimbursement than the usual East/M codes, but they come up with new expectations likewise. Your office is now expected to attain out to the patient, rather than wait for the patient to call you. And you are expected to do this apace – within two business organisation days.

The Federal Register went into great detail most the new codes,^three 99495 and 99496, yet some questions remain. It is likely that we volition meet farther clarifications after the Centers for Medicare & Medicaid Services (CMS) and the CPT Editorial Panel make additional recommendations afterward in 2013. While CMS has been instrumental in the creation of these new codes, they are pertinent outside of Medicare and will bear on your commercially insured patients as well.

Here'due south what we know now near the TCM codes.

Defining "belch"

Abstract
Defining "discharge"
Initial contact required within two business days
The confront-to-confront visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to beak for other services
What do these codes pay?
Who can bill these codes?
How do you quickly find out that the patient was discharged?
How practise you become the information you need?
Figure out your function workflow
References

For the purpose of TCM, "discharge" refers to a discharge from an inpatient setting such every bit an acute intendance infirmary, rehabilitation hospital, long-term acute hospital, or skilled nursing facility. Information technology also refers to discharge from observation condition in a hospital, or from a partial infirmary programme, which is a program for mental health and substance abuse disorders that involves spending the day at the handling center and the dark at domicile. No other discharges are allowed under the guidelines. Emergency section discharges are excluded, as well as discharges from assisted living facilities.

Initial contact required within two business organisation days

Abstract
Defining "discharge"
Initial contact required within two business days
The face-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to beak for other services
What practise these codes pay?
Who can bill these codes?
How practise you quickly find out that the patient was discharged?
How do you get the information you need?
Figure out your role workflow
References

Contact with the patient, family unit fellow member, or caregiver must occur within two business days afterward discharge. Business organization days are Monday through Friday from 8 a.grand. to five p.one thousand. Nights, weekends, and holidays don't count toward the ii-24-hour interval allowance.

Contact can be made by the provider or designated clinical staff and can be made by telephone, electronically (east.g., via a patient portal), or in person. This communication must be documented in the patient'south chart and should be more noun than merely scheduling the follow-upward confront to face visit. The provider'due south office should try to gather every bit much data as possible regarding the belch diagnoses, procedures performed, and what follow-up services the patient might require.

Medication reconciliation should be initiated likewise, although it does non have to be completed until the face up-to-face up visit. Patients should be asked whether they are on any new medications and, if they aren't sure, to bring in all the medications they are taking and whatever new prescriptions they've received. The discharge summary volition often incorporate much of this information, but many times this summary is non available when the provider (or designated staff) makes the initial contact within the two-business-day fourth dimension frame.

CMS states that if the provider (or designated staff) attempts to contact the patient or caregiver at least twice and is unable to make contact inside two business days, the provider may still beak the TCM codes if all the other criteria are met during the 30 days afterward discharge. The two failed attempts must exist documented in the patient'south chart or the TCM codes cannot be billed (no exceptions).

If past chance a patient contacts you or comes into the function inside two days of belch and y'all talk over the discharge so, you will take met the contact requirement. Come across below for a paper or electronic template you can use to document this initial contact.

INITIAL TRANSITIONAL Care CONTACT

Download in PDF format

Patient proper name: ______________________________________

Engagement of contact: ___/___/___

Sources of information:

[ ] Patient, family fellow member, or caregiver (Name: ______________________)

[ ] Infirmary discharge summary

[ ] Infirmary fax

[ ] List of recent hospitalizations or ED visits

[ ] Other ___________________________________

Discharged from: __________________________________ on ___/___/___

Diagnosis/problem: ________________________________________________________

Medication changes: [ ] Yes [ ] No

Medication list updated: [ ] Aye [ ] No

Needs referral or lab: [ ] Yes [ ] No

Needs follow-up date:

[ ] Within 7 days of discharge (highly complex visit).

[ ] Within fourteen days of belch (moderately complex visit).

Appointment fabricated for ___/___/___ with _________________________

Additional information needed and requested:

[ ] Yes: __________________________________________________________

[ ] No

The confront-to-confront visit: complication and timing

Abstruse
Defining "discharge"
Initial contact required within 2 business days
The face-to-face visit: complication and timing
Components of TCM
When to submit the TCM merits, and when to bill for other services
What exercise these codes pay?
Who can bill these codes?
How do you quickly find out that the patient was discharged?
How do you get the information you demand?
Figure out your office workflow
References

A confront-to-face visit with the provider must occur within seven to 14 calendar days afterward discharge. However, if the patient is seen for follow-up of his or her discharge within two concern days, then that visit meets the initial contact and contiguous visit requirements.

Code 99496 should be used if the face-to-face visit requires medical decision making of loftier complexity inside 7 days; lawmaking 99495 should be used if the contiguous visit requires medical decision making of moderate to loftier complexity inside 7 to 14 days (see the code requirements below). For ease of understanding, think of the complexity as similar to the conclusion-making complexity component of an E/M role visit code. If the patient has a potentially life- or limb-threatening trouble with a significant risk of readmission within the adjacent thirty days and/or if you have to review a large amount of testing and consultation data and yet diagnostic uncertainty persists, high complexity decision making (99496) is likely. In this highly circuitous scenario, information technology wouldn't be safe to make the patient wait more a week to encounter you. Otherwise, it is more likely that the situation falls in the moderately complex (99495) realm.

Code REQUIREMENTS

The transitional intendance management codes require ane face-to-face visit, sure not-face-to-face services (as described in the article), and medication reconciliation and management during the 30-twenty-four hour period service flow.

Code 99495 has the following requirements:

Communication (direct contact, telephone, or electronic) with the patient or caregiver inside two concern days of discharge,
Medical decision making of at least moderate complexity during the service catamenia,
A face-to-confront visit inside 14 days of discharge.

Lawmaking 99496 has the following requirements:

Communication (direct contact, telephone, or electronic) with the patient or caregiver inside two business days of discharge,
Medical decision making of high complexity during the service menses,
A confront-to-face visit within seven days of discharge.

Components of TCM

Abstract
Defining "discharge"
Initial contact required within ii concern days
The face up-to-confront visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to bill for other services
What do these codes pay?
Who tin beak these codes?
How practice you speedily find out that the patient was discharged?
How do you go the information you need?
Effigy out your function workflow
References

Many of the services associated with TCM volition occur exterior the face-to-face visit. CMS states that clinical staff, under the management of the physician or nonphysician provider, may provide the following non-face-to-face services:

Brand the initial contact with the patient or caregiver,
Communicate with domicile health agencies and other community services the patient uses,
Educate the patient or caregiver regarding self-direction, independent living, and activities of daily living,
Appraise the patient'south adherence with his or her treatment regimen, including medication apply, and provide back up,
Identify community and health resources bachelor to the patient,
Help the patient or family get access to intendance and services they may need.

The physician or non-md provider must perform the following non-contiguous services:

Obtain and review the discharge data,
Review the demand for follow-up on pending diagnostic tests and treatments,
Interact with other qualified health care professionals who will assume or reassume care of the patient'due south system-specific bug,
Educate the patient or caregiver on issues not addressed past staff,
Establish or reestablish referrals, and society whatever needed community resource,
Order any required follow-upwards with community providers and services.

The face-to-face visit, then, will involve primarily an examination of the patient, medication reconciliation (if it was not completed previously), and possibly creating orders for follow-upward testing, referrals, or other services (such as pedagogy programs, community services, rehabilitation services, durable medical equipment, and home health) All of this should be documented.

It is a practiced idea to make reference to your initial contact note in the face up-to-face visit note. These ii notes do not have to be combined into one. See below for a recommended paper or electronic template to use in the plan section of your face-to-face up visit note.

Confront-TO-FACE TRANSITIONAL Care VISIT DOCUMENTATION

Download in PDF format

For use in plan department of visit note.

Medication reconciliation:

[ ] Medication list updated

[ ] New medication list given to patient/family/caregiver

Referrals:

[ ] None needed

[ ] Referrals made to: _________________________________

Community resources identified for patient/family:

[ ] None needed

[ ] Habitation health agency

[ ] Assisted living

[ ] Hospice

[ ] Support group

[ ] Education program: ________________________________

Durable medical equipment ordered:

[ ] None needed

[ ] DME ordered: ______________________

Additional advice delivered or planned:

[ ] Family/caregiver: ___________________________

[ ] Specialists: _________________________________

[ ] Other: _____________________________________

Patient education:

Topics discussed: _____________________________________________________

Handouts given: ______________________________________________________

Initial transitional care contact was fabricated on ___/___/___ (meet separate notation)

When to submit the TCM claim, and when to bill for other services

Abstruse
Defining "discharge"
Initial contact required within two concern days
The face up-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to pecker for other services
What do these codes pay?
Who tin can bill these codes?
How practice you rapidly find out that the patient was discharged?
How do yous become the information you need?
Figure out your role workflow
References

Because the TCM codes represent a 30-day service period, they should be billed no sooner than the 30th day after the patient was discharged – non at the conclusion of the face-to-face visit – and the date of service should be the 30th day later belch. These codes should not exist used more than in one case every 30 days after the initial mean solar day of discharge. If a patient returns to see you for the same trouble after the initial TCM visit but earlier the 30 days are up, you tin still nib for that visit but volition need to use an E/G office visit code such every bit 99213 or 99214.

Additional E/K services, including preventive services, provided on the same twenty-four hour period as the contiguous TCM visit cannot exist billed separately; however, additional E/M services provided subsequently the face-to-face TCM visit can be billed separately. Labs, electrocardiograms, etc., can also be billed separately, even if they occur on the same day as the face-to-face TCM visit. Services such equally intendance plan oversight and anticoagulation direction cannot be billed at all during the menses covered by the TCM codes. The total list of services that cannot be billed is found in the 2013 CPT guidelines.

What practice these codes pay?

Abstract
Defining "belch"
Initial contact required within two business days
The face-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to neb for other services
What do these codes pay?
Who tin can bill these codes?
How do you quickly find out that the patient was discharged?
How do you get the information you lot need?
Effigy out your part workflow
References

Noridian, a CMS contractor for a large part of the western U.s. (including Arizona where we alive) pays approximately $162 for 99495 and $229 for 99496. This compares quite favorably to the reimbursement for established patient office visits 99214 at $105 and 99215 at $141, or new patient function visits 99204 at $163 and 99205 at $202. Y'all'll want to bank check the reimbursement rates for these new codes from the Medicare contractor in your area. They should be like to these numbers. Additionally, many other insurance carriers are now paying for these codes.

While new and established patient visits tin exist billed using the TCM codes (per the Federal Register and recent CPT changes), payment is the same for both. You may prefer to bill a new patient code (99204 or 99205) in lieu of a TCM code based on the blazon of exam and information that you need to collect on a new patient. For established patients, you will clearly see an increased benefit to your lesser line when y'all use the TCM codes rather than the Eastward/M office visit codes.

Who can pecker these codes?

Abstract
Defining "discharge"
Initial contact required within two business days
The face-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to bill for other services
What practise these codes pay?
Who tin can pecker these codes?
How do you rapidly notice out that the patient was discharged?
How do y'all go the information you demand?
Effigy out your role workflow
References

Specialty designation of the provider has not been specified other than to say that dentists and podiatrists cannot pecker these codes. Surgeons who have performed a surgery during the hospitalization typically cannot bill these codes because most surgical follow-up visits are covered under the original surgical payment, which often includes a global period that lasts longer than the seven- to 14- 24-hour interval flow during which the face-to-face TCM visit must occur. Notwithstanding, a discharging physician (other than the physician who performed surgery) can apply these codes on the 30th day after belch. Nonphysician providers such equally physician assistants and nurse practitioners may as well neb these codes following the incident-to coding rules.

A key bespeak to remember is that but 1 provider, per patient and per discharge, may bill a TCM code during the xxx days following discharge. This creates a potential conflict if the patient follows upward with more one medico post-discharge, a common occurrence. It appears that the beginning provider to bill volition exist the one to receive payment.

How practice y'all chop-chop find out that the patient was discharged?

Abstract
Defining "discharge"
Initial contact required within two business organisation days
The face-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to bill for other services
What do these codes pay?
Who tin bill these codes?
How exercise yous quickly find out that the patient was discharged?
How practice you get the information you need?
Figure out your function workflow
References

The toughest problem with these codes is the requirement to contact the patient within two business days of discharge. This is no trouble at all if you are the discharging physician, simply many family physicians no longer work in the hospital. It is not uncommon for a family medico to be notified of a discharge more than than 2 days afterwards the event or sometimes non at all. So how do you become timely notification? This is a problem that will likely have unique solutions in every setting, merely hither are a few suggestions:

Piece of work with your local hospitals. For example, request aforementioned-24-hour interval fax notification – or, even better, a secure email exchange or a phone call – when your patients are discharged from all area hospitals. If y'all are not part of a big medical grouping or integrated system that tin push for this, perhaps your local medical order tin help. Given the new CMS penalties for hospitals with high readmission rates for certain medical conditions, it is in the infirmary's best interest to make sure the transition of intendance goes well.
Work with your patients. Brainwash your patients to notify your office, or have a family unit fellow member notify your part, whenever they are admitted to a hospital. When you acquire that a patient has been admitted, accept your staff follow up with the patient or family and ask them to contact your function upon discharge.
Piece of work with your hospitalists. If you interact with 1 or more specific hospitalist groups, you may be able to work out an arrangement where they notify you (by fax, telephone, electronic mail, or text) the day your patients are discharged.
Pay close attention to those discharge faxes. Don't let them sit in a stack of unread papers. Create an office process to human action on the discharge notice as before long every bit it is discovered.

How do y'all get the information you need?

Abstract
Defining "discharge"
Initial contact required within two business days
The face up-to-face visit: complexity and timing
Components of TCM
When to submit the TCM merits, and when to bill for other services
What practise these codes pay?
Who can bill these codes?
How practice you quickly find out that the patient was discharged?
How practice y'all get the information you demand?
Figure out your office workflow
References

One of the advantages of contacting the patient earlier the face-to-confront visit is that you and your staff can learn what occurred during the acute care stay and can then proactively obtain relevant belch summaries, operative reports, imaging reports, tests, labs, and consult notes. This volition prevent the dismay of having a patient show upwards later on a hospitalization and you and your staff having no idea what happened to the patient.

If you already have a great way of automatically getting detailed information within a day or 2 of the patient'southward discharge, bravo! You are in a much better situation than virtually physicians. The traditional fashion to get details nearly a patient's hospital stay has been to contact the hospital records section. That is not always an efficient process. More and more hospitals are offering doctor portals where doctors can view and download patient records. If that is available to you, sign up. You should try to get access to the portal of every hospital in your community. Designate one or more than staff to log on and download the data you need. If you are lucky enough to be part of a health information exchange in your customs, you may need only i log-in versus dissever log-ins for each facility.

Figure out your part workflow

Abstract
Defining "discharge"
Initial contact required within two business days
The face-to-face visit: complexity and timing
Components of TCM
When to submit the TCM claim, and when to pecker for other services
What do these codes pay?
Who can pecker these codes?
How practice you quickly observe out that the patient was discharged?
How do you get the information you need?
Figure out your office workflow
References

One time yous learn that the patient was discharged, you lot take precious footling time to deed. Make sure your function has figured out what should happen afterward you lot learn nearly the belch. Who will call the patient? Who makes sure additional records are obtained? Who makes the face-to-face visit appointment? We recommend the use of a paper or electronic templates, as described earlier, for managing key steps in the transition of care workflow.

In addition, practices volition need to develop a tracking arrangement that reminds them to nib for these services at xxx days postal service-discharge. Solutions could range from creating a tickler file to creating a new appointment code for TCM and running weekly reports to run across which patients have reached the 30-day window.

All of this requires actress piece of work, but about of it is work that y'all have probably already been doing. Now you can be paid fairly for information technology, and your patients will do good. Adept luck on your transitions of care!

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About the Authors

Jacqueline Bloink is director of compliance at Arizona Community Physicians, a physician-owned, primary care medical group in Tucson, Ariz., and is a coding and compliance consultant. Dr. Adler is a practicing family medico, a medical managing director for Arizona Community Physicians, and medical editor for Family Practice Management. Writer disclosures: no relevant fiscal affiliation disclosed.

Transport comments to fpmedit@aafp.org, or add your comments below.

References

1. Current Procedural Terminology 2013: Standard Edition. Chicago: American Medical Association; 2012.

2. The Revolving Door: A Report on US Hospital Readmissions. Princeton, NJ: Robert Wood Johnson Foundation; February 2013.

iii. "Medicare Program; Revisions to Payment Policies Under the Doc Fee Schedule, DME Face-to-Face Encounters, Emptying of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013 (Concluding Dominion)." Federal Register. 2012;77(222):68978-68994.

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