DecisionHealth, DecisionHealth - 2016 Issue 4 (April)

Transitional care management Q & A

Question: I recall reading an article when the transitional care management (TCM) codes debuted stating that if a provider (or designated staff) attempts to contact the patient or caregiver at least twice and is unable to make contact within two business days, the provider may still bill the TCM codes if all the other criteria are met during the 30 days after discharge. My question is this: If the provider or designated staff was not able to make contact within two business days post-discharge, and the contact attempts are documented, and all the other criteria for TCM are met within the 30 days after discharge, is TCM a billable event?
 
Question: CMS says that we can claim transitional care management (TCM) codes 99495 and 99496 even if the patient goes back into the hospital during the 30-day period. Yet I have seen a presentation that says such charges will be denied. Is that so?

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