Family physicians who serve Medicare patients are scrambling to understand the intricacies of two new CPT codes created to cover transitional care management (TCM) services. Specifically, codes 99495 and 99496 were approved by CMS last fall and became available to physician practices in January.
The CPT codes cover services provided when a patient's condition requires moderate- (99495) or high-complexity (99496) medical decision-making as the patient is transitioning from inpatient hospital care to his or her home or another community setting.
The AAFP has created two free tools to help members get comfortable assimilating the new codes into their billing processes.
The first tool, a frequently-asked-questions (FAQ) document(2 page PDF) provides concise answers to 21 basic questions about the new codes. For example, the FAQ sorts out
- when to use TCM code 99495 versus 99496,
- coverage of services delivered in a manner other than face-to-face,
- expected payment for each code,
- specific time elements associated with the new codes, and
- circumstances that would limit physician use of either TCM code.
The AAFP also created a transitional care management 30-day worksheet(2 page PDF) designed to help FPs log important information in the patient's transitional care summary, including must-have dates and discussion notes regarding
- interactive contact and seven-day and 14-day face-to-face visits;
- medications at discharge and medication changes or adjustments;
- collaboration with other health care professionals; and
- delivery of patient education about his or her illness or disease.
The worksheet also helps physicians assess and tabulate the level of their medical decision-making -- be it moderate or high -- during a patient's care transition.
The last line on the form reminds FPs to submit billing 30 days after the patient's discharge.
Physicians also may find it helpful to review two entries about payment for transitional care management that were published in Family Practice Management's Getting Paid blog. The most recent blog entry posted on Feb. 12 and details some situations that have caused confusion since the codes went into effect, and a Nov. 29 blog post announces the new codes and provides a basic overview.