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Transitional care management 99495, 99496

Kathy Posted Mon 13th of May, 2019 06:45:57 AM
I work in Kansas in a cardiology clinic. There are several cardiologist that work in this practice. We are interested in TCM. We are not sure how to approach this issue. Lets say that one of the cardiologist admits the patient to the hospital and another cardiologist in the same practice under the same tax ID number discharges the patient. Can the midlevel provide TCM face to face contact with the patient in the clinic under direct supervision with either cardiologist or should it only with the discharging cardiologist (the one who made the discharge plan of care)? Thank you
SuperCoder Answered Tue 14th of May, 2019 07:14:52 AM

Hi Kathy,

 

The requirements for TCM services include:

 

  • The services are required during the beneficiary’s transition to the community settingfollowing particular kinds of discharges

 

  • The health care professional accepts care of the beneficiary post-discharge from the facility setting without a gap

 

  • The health care professional takes responsibility for the beneficiary’s care

 

  • The beneficiary has medical and/or psychosocial problems that require moderate or high complexity medical decision making

 

The 30-day TCM period begins on the date the beneficiary is discharged from the inpatient hospital setting and continues for the next 29 days.

 

HEALTH CARE PROFESSIONALS WHO MAY FURNISH TCM SERVICES

 

These health care professionals may furnish TCM services:

  1. Physicians (any specialty)

 

  1. These non-physician practitioners (NPPs) who are legally authorized and qualified to provide the services in the State in which they are furnished:

 

  • Certified nurse-midwives (CNMs)
  • Clinical nurse specialists (CNSs)
  • Nurse practitioners (NPs)
  • Physician assistants (PAs)

 

When we use “you” in this publication, we are referring to these health care professionals.

CNMs, CNSs, NPs, and PAs may furnish non-face-to-face TCM services “incident to” the services of a physician and other CNMs, CNSs, NPs, and PAs.

 

SUPERVISION

 

The required face-to-face visit must be furnished under a minimum of direct supervision and is subject to applicable State law, scope of practice, and the Medicare Physician Fee Schedule (PFS) “incident to” rules and regulations. The non-face-to-face services may be provided under general supervision. These services are also subject to applicable State law, scope of practice, and the PFS “incident to” rules and regulations. The practitioner must order services, maintain contact with auxiliary personnel, and retain professional responsibility for the service.

 

Please find below the link from CMS on TCM for more understanding:

 

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf

 

Thanks!

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