Transitional Care Management

Description

Transitional Care Management (TCM) is a critical component of healthcare aimed at ensuring the smooth transition of patients from an inpatient setting to their community setting after discharge. This course provides an in-depth exploration of TCM, its definition, and the essential documentation requirements associated with it.

Included Lessons:

• What is Transitional Care Management (TCM)
• Inpatient Setting
• Community Setting
• TCM Services Billing Providers
• TCM Components 
• Interactive Contact
• Non-Face-to-Face Services
• Face-to-Face Visit
• Supervision Stipulations
• TCM CPT Codes
• Documentation Requirements
• Billing Guidelines 
• Unusual Situations
• Organizational Impact 

Key Takeaways

In this course on Transitional Care Management (TCM), we've explored the essential elements and guidelines for providing effective care to patients transitioning from an inpatient setting to their community setting. TCM is a crucial aspect of healthcare that involves various components, documentation requirements, and billing guidelines. The key takeaways from this course include:

• Definition of TCM: Transitional Care Management is an evaluation and management (E/M) service provided for patients who are discharged from an inpatient setting to their community setting, involving moderate to high complexity medical decision making during the transition in care.
• Duration: TCM services cover a 30-day period that starts on the day of discharge and continues for the next 29 days.
• Types of Inpatient Settings: TCM services are provided following discharge from various inpatient settings, including acute inpatient hospitals, rehabilitation facilities, psychiatric hospitals, long-term acute care hospitals, hospital outpatient observation, partial hospitalization, and more.
• Community Settings: Patients must be returned to a community setting following discharge, which can include residential homes, domiciliary care, rest homes, and assisted living facilities.
• Eligible Providers: TCM services can be billed by physicians (of any specialty), nurse practitioners (NPs), physician assistants (PAs), certified nurse midwives (CNMs), and clinical nurse specialists (CNSs).
• TCM Components: Three components must be provided during the 30-day TCM period: interactive contact, non-face-to-face services, and a face-to-face visit.
• Interactive Contact: Contact with the patient and/or caregiver must be made within 2 business days following discharge, using methods such as email, telephone, or face-to-face. Continual attempts to contact the patient are expected until successful.
• Non-Face-to-Face Services: These services may include helping patients access needed care, identifying health and community resources, providing education, managing medications, and reviewing discharge information.
• Face-to-Face Visit: A face-to-face visit must be conducted within either 14 days or 7 days of discharge, depending on the specific CPT code. Medication reconciliation must occur by the date of the face-to-face visit.
• Supervision Stipulations: TCM services require direct supervision for the face-to-face visit and general supervision for non-face-to-face services, in accordance with state law, scope of practice, and incident-to guidelines.
• TCM CPT Codes: The relevant CPT codes for TCM services are 99495 (moderate complexity) and 99496 (high complexity).
• Documentation Requirements: Important elements to document include dates of discharge, interactive contact, face-to-face visit, service date, place of service, medical decision making complexity, and more.
• Billing Guidelines: TCM services should be reported only once during the TCM period, and subsequent E/M services can be reported separately. TCM cannot be billed if it overlaps with a global period for a procedure code by the same practitioner.
• Date of Service: The date of service reported on the claim should be the date of the required face-to-face visit, and claims can be submitted once that visit is completed.
• Unusual Situations: TCM services can still be reported if a patient is readmitted within the 30-day TCM period, and the patient's demise before the 30th day requires a different E/M code, not a TCM code.

Benefits of Taking this Course

• Enhanced Coding Skills 
• Professional Development
• Improved Coding Accuracy
• Expanded Knowledge Base

FAQs

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams.