In order to bill a TCM visit, is anything else needed besides the phone call and E/M visit? (Codes 99495 and 99496)
Yes, I’m so glad you asked. Let’s go to CPT®.
“TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non-face-to- face services that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his/her direction.”
In addition to the phone call within two business days, and the E/M visit of moderate (within 14 calendar days) or high complexity (within 7 calendar days), review of the discharge summary and medication reconciliation, non-face-to-face services by clinical staff or the physician/NP/PA are required.
Without these additional non-face-to-face services, you cannot bill TCM.
These non-face-to-face services can be provided by clinical staff members or the physician/NP/PA at any time during the 30-day calendar period. Don’t count the phone call, because it is a separate, required service.
The CPT® lists examples as “may include” which means you don’t need to perform all of them, just one of them. Simply, it is additional patient education, supportive phone calls, or coordination with community resources or health care professionals. CPT® divides the list into those that are performed by clinical staff under the supervision of the clinician and those performed by the clinician, themselves. Some groups can document this work in a TCM template, and some groups use a phone note.
Be sure to get out your CPT® book and read the section on TCM if you are performing and billing for the service. Don’t automatically bill a TCM service for every discharged patient who is seen in the office.
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