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Posts: 30
Reply with quote  #1 
Are any of your practices using the TCM 99495/99496 codes?  If so, any policies or procedures that can be shared? Our physicians want to use them, but how is it determined which discharged patients qualify.  CMS is so gray on what is required, it almost appears any hospital follow-up done in 7 or 14 days can be billed as long as the patient is contacted two days from discharge.  

I feel it should be patients that require continuity of care in the community, but my docs argue that is not a written requirement.  They feel seeing any discharged patient, reviewing med lists and sending them on their way for a 3 month follow-up with the instructions to call if you need us is sufficient.  They document it just like an office visit.

Looking for some guidance.
Reply with quote  #2 
Your physicians are wrong. TCM is not to be used for routine hospital D/C. The patient has to be at high risk for readmission and require support at a higher level due to social or other issues. If you just google "TCM requirements" there is tons of information, including a medicare fact sheet on TCM available. If you send me your email I can send you the information I have. We have providers using TCM codes, but they are reviewed by coders 100% since it is used so incorrectly, as you say. If the note/patient do not meet TCM requirements, we flip the code to an est pt followup code and notify the MD, send info to re-educate. 

Posts: 30
Reply with quote  #3 
I am not sure how to private message you my email address.  I would like what info you have to share.  

Posts: 1
Reply with quote  #4 
We are using TCM 99245 and 99246 in our nurse practitioner staffed heart failure specialty clinic.  We see the patient while they are in-house, do heart failure teaching and make recommendations to the house staff, then call the patient within 24-48 hours after discharge to do a "condition check".  That conversation may last up to 45 minutes, with medication reconciliation actually reviewing the pill bottles and instructions, reviewing education (sodium, fluid restriction, daily weight, symptoms to watch for) and discussing goals of care, contact information to call the on-call NP with any/all questions and review of any outstanding lab work).   On the day of discharge the NP schedules an appointment for that patient to come to the clinic ideally within 5 days of discharge (our hospital care council mandate).  Depending upon the patients condition, we may do daily phone checks on that patient until they are seen in the clinic.  We typically will see the high-risk heart failure patient once a week for a couple of weeks and then again in 2 weeks, but this of course depends on the needs of the patient.  Phone calls are usually a minimum of twice a week (not by design but this seems to be the average) as we are keeping very close tabs on symptoms throughout the initial 30 days post-discharge. There are a handful of patient that we do talk with every day. We involve home health with the majority of our patients, and use telehealth monitoring. We are also mandated to charge a facility fee, which we are very confused about, given the global nature of the TCM services fee, so if anyone has info on that, it would be so appreciated. 
After the 30 days are up, we often continue to follow that patient, up to 90 days actually, to make sure they are up-titrated on their medications, and will "discharge" them once they are fairly stable and will transition them to the next level of care.  Most of the time it will be back to their primary cardiologist, sometimes it will be to the advanced heart failure clinic, to EP, or back to their primary care provider.  We focus on re-education about medication, diet, lifestyle changes, etc. with all of these patients (as that is a part of the reason they are high-risk in the first place).  Many of them are complex patients, with renal insufficiency, diabetes, arrhythmias, and although we don't always directly manage these things to resolution, we often will refer a patient to the appropriate specialty if needed.  We always screen for sleep apnea and refer them on, if needed. Our goal is to reduce all-cause readmission for a patient whose index admission is heart failure.  We have been in operation just over 3 months and we are doing quite well with reduction of all-cause readmission and particularly well in reducing readmissions for heart failure.  
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