tci Medicare Compliance & Reimbursement - 2018 Issue 9

Reader Question: Know These TCM Discharge Requirements for E/M Claims

Question: What types of discharge fall under the transitional care management codes? California Subscriber Answer: The evaluation and management transitional care management (TCM) codes you mention are: 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 period face-to-face visit, within 14 calendar days of discharge) 99496 (... medical decision making of high complexity during the service period face-to-face visit, within 7 calendar days of discharge). With TCM, the provider delivers services...

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