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CSW TRANSITIONAL CARE FOR HEART ATTACK PATIENT

Brett Posted Wed 31st of August, 2011 22:59:10 PM

OUR SOCIAL WORKER PROVIDES SERVICE IN CONJUNCTION WITH THE HOSPITAL MD TO PROVIDE TRANSITIONAL CARE. WHAT CPT/HCPC CODE CAN WE USE?

SuperCoder Answered Thu 01st of September, 2011 07:16:36 AM

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.
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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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Other probable existing CPT codes are based on the following concept:-
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.
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For example, your patient is discharged from the hospital and placed in a transitional care unit so 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).

SuperCoder Answered Thu 01st of September, 2011 07:25:59 AM

If assistance is provided by clinical social worker, then it is necessary to know the place of service where social worker provided the support or services.

If place of service is home health or hospice care then report G0155. For tele health services, look for 98966-98968.
Also for other place use normal CPT code from medicine section (as applicable) and add modifier "AJ" for CSW.

Remember we can't use E/M CPT codes for Clinical social worker.

SuperCoder Answered Thu 01st of September, 2011 14:30:59 PM

Sorry! CPT 99301-99303 is a deleted one, the correct code sets has to be 99304-99310

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