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Billing for rounds

Brett Posted Thu 25th of August, 2011 22:00:02 PM

We are initiating a transitional care management program with providers on site/in hospital to initiate care and assist in coordination of care post discharge. They will be doing case management and working with the treatment team during rounds. How can we bill, or what is the best way to bill, for these services?

SuperCoder Answered Fri 26th of August, 2011 22:01:15 PM

Care provided in a transitional unit is typically considered part of either the discharge or the initial visit at the next facility to which the patient is transferred.

If a patient is discharged from the hospital and placed in a transitional care unit so that you can monitor her to determine the next step in her care. At the transitional unit, you evaluate her and decide to admit her to a nursing facility. Upon her admission to the nursing facility, you perform a comprehensive nursing facility assessment. You should bill for comprehensive nursing facility assessment only, selecting a level of service that accounts for the complexity of the transitional care unit service (CPT 99301-99303).

If your patient were not admitted to a nursing facility, you would consider the transitional care services part of the initial hospital discharge services.

AMA CPT states that you can bill CPT 99499, unlisted evaluation and management service, if you believe that you provided a separate service in the transitional care unit. However, you need to submit a written report explaining how the service is not captured by an existing CPT code.

If a patient is in a transitional care unit for an extended period, check with the hospital or other facility to see how it classifies its transitional care unit.

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