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Tauna Posted Fri 12th of July, 2013 13:34:58 PM

I need your help on the following scenario:

My provider sees a patient in the hospital for a certain amount of days and then discharges patient. I bill out -- no problem. But then my provider reports that he has seen this same patient, on the same hospital's TCU floor, for several visits and a discharge. In other words, when he reported the discharge the first time, it was discharge from the hospital's inpatient floor to the hospital's TCU floor -- not discharge from the hospital completely. How would I bill this?

I hope that makes sense. Thanks for your help.

SuperCoder Answered Mon 15th of July, 2013 12:17:06 PM

Medicare will only pay one physician or qualified practitioner for TCM services per beneficiary
per 30 day period following a discharge. If more than one practitioner reports TCM services
for a beneficiary, Medicare will only pay the first eligible claim submitted during the 30 day period that
commences with the day of discharge. Other practitioners may continue to report other
reasonable and necessary services, including other E/M services, to beneficiaries during
those 30 days.

Medicare will only pay the first TCM claim received per beneficiary in one 30-day period beginning on the date of discharge, so if more than one practitioner reports the code for the same patient, only the doctor whose claim is received first will get paid.

Tauna Posted Mon 22nd of July, 2013 13:38:36 PM

So the TCM codes are our only option to use in this scenario? Before we had the TCM codes, what was the proper way to bill this out? I mentioned this to my provider and he maintains that the hospital's TCU falls under SNF services -- with the location being at the hospital instead of a different facility.

Thanks for your help.

SuperCoder Answered Wed 24th of July, 2013 00:17:39 AM

It will depend on whether transitional care is covered by the payer, and what the hospital lists the patient's status as - inpatient or outpatient. There are no CPT codes for physician services in this setting unless the hospital considers it to be observation care. If the hospital considers this to be SNF care, you might get paid, but not for discharge from one setting to admission to the next setting. Again, you will have to contact your specific payer to find out what will be covered.

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