Home Forums Discussions Coding and Billing Transitional Care Codes

It does not appear that AC recognizes the transitional care codes 99495 and 99496. How do you complete the coding and sign off on a medical record when there is no applicable CPT code? I think this has also been a problem for some of the G-codes. Is there a way to define your own code? I would like to know how other AC users deal with these issues.

Worse than that, it does not appear that Medicare recognizes them! I have not been paid for one yet. Even though you have to see the patient within 2 weeks of discharge, you have to bill the DOS for 30 days after DC....at least that is what Medicare told me.

So, obviously when you signed off on these patients that you've already billed, you were not able to code it correctly with AC. Is that a safe assumption? How long after the 30 day period have you been waiting to get paid?

I do not code with AC so not an issue. I gave up on using this code and just went back to a 99215, paid less.

Same problem here, Leslie.
Our claims have now been resubmitted, so I am waiting to see if paid.

The transitional care codes cover a period of time, not the date of visit. The period starts on the discharge date and runs for 29 more days. So, you can't bill with DOS until 30th day.

To recap what I think are the requirements, you must contact the patient within 2 days of discharge, see the patient within 7 or 14 days of discharge (depending on code used), then submit claim with DOS 30th day or later.

ACP is collecting information on denials, Debra Lansey in ACP Health Policy and Regulatory Affairs Department, dlansey@acponline.org. You can send the details of your denied claim if desired.

I don't use AC for coding, but you can add new codes in the administrator options, tools menu, if desired.

That is my understanding too, Donna....makes absolutely no sense. Our PM system needs to capture the charge on the date of the encounter, not 29 days later. So, do we lie about the DOS or the date of billing? I have resubmitted at least twice and still never been paid....a huge waste of time and energy. Pissed patients off telling them they HAD to follow up in the office within 2 weeks whether it was convenient for them or not, whether they could even get out of the house yet after their brain surgery or double mastectomy, didn't matter, this was Medicare's rule, not mine. More examples of this health care system being destroyed by people who know nothing about medicine and caring for patients, not to mention how to remain solvent and get paid. Stupid idiots.

I'm running into denials too and am re-submitting the claims 30 days after discharge - we'll see what happens. One other thing - I guess Medicare won't process the claim until they've received the bill from the facility the patient was discharged from.

Although this is being poorly administered so far, I see this as theoretically a win-win-win for patients, providers and Medicare. All of my patients have been happy to get the phone call and happy to get in within a week. If Medicare starts paying I get better reimbursement and if I prevent re-admissions Medicare is happy. Hopefully Medicare can make reimbursement easier.

To play the devil's advocate--

The flipside, if you see your patient 2-3 times in the 30 day time frame, you are not able to submit an additional charge, so this bundling of payment may in fact reduce your overall payment for complex patient care.

We have several docs who have started getting payments, but you have to wait the 30 days before submitting charge, and then it is taking about 3 weeks from submission before payment arrives.

Well, this is contrary to my understanding, which is that CMS will allow additional billing of 9921x codes within the 30 day period but obviously only one TCM (99495 and 99496)is allowed within that time frame.

Q. If the patient needs an unrelated evaluation and management (E/M) visit during the 30 days can I bill for this?
A. Yes, although there are some restrictions on what you can bill, such as anticoagulation management and home health care certification.
http://blogs.aafp.org/fpm/gettingpaid/entry/decoding_the_new_tcm_rules

Ron

Q. If the patient needs an unrelated evaluation and management (E/M) visit during the 30 days can I bill for this?
A. Yes, although there are some restrictions on what you can bill, such as anticoagulation management and home health care certification.

Ron,

I have a partner that had to eat two office visits. He saw the patient unexpectedly two separate times in the office for the same problem he was hospitalized for within the first 30 days post hospital. As I understand it there are two levels for the TCM, but if you see the patient in the office for the same problem you are unable to bill for those visits, the TCM code encompasses all related care to the issue at hand within the first 30 days post hospital. So if it is unrelated then I think you are right.