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Stephen O'Connor

By: Stephen O'Connor on April 6th, 2016

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What Your Practice Should Know About Transitional Care Management

Value-Based Care

Transitional Care ManagementThe type of medical organization you run has a great deal to do with whether many of your patients will require transitional care management, but TCM is an issue you should stay on top no matter how often it comes up of because industry and government updates can influence the way you do business.

For example, the American Medical Association has developed two brand new codes for the Current Procedural Terminology database that you’ll want to keep in mind. 

What’s more, since Medicare now allows medical organizations to bill insurers for 30 days of TCM, you’ll want to take advantage of this so you can boost revenue for services that you may not have been paid for in the past.

Here is the latest on what your practice should know about transitional care management.

Two Important New TCM Codes to Know About

The AMA has added two current procedural terminology or CPT codes that you and your staff should be aware of:  99495 and 99496.

Code 99495 addresses the communication you make with patients or their caregivers within two days of the patient’s discharge when the medical decision making process is of the least moderate complexity, noted a recent article at the American College of Physicians website. There must also be a face-to-face visit within 14 business days of the discharge and there is no requirement about where this encounter must take place.

Code 99496 has to do with communications with caregivers or their patients within two days of discharge but the medical decision making process is deemed to a matter of high complexity. In these cases, the face-to-face visit must take place within 7 days instead of two weeks with less complex situations.

Goal Is to Reduce Hospital Readmissions

As dedicated medical professionals, we want to provide our healthcare treatment services as efficiently as possible. This includes taking steps to arrange for better care when patients are ready to transition from the facility to back home.

Qualified Professionals (or QPs, the term given for certified nurse midwives, clinical nurse specialists, nurse practitioners, physician assistants and physicians) are required to contact a patient or the caregiver of a patient within two business days after the patient was discharged. This is to ensure continuity of care and to make sure nothing falls through the cracks. You can make contact at the facility itself, but the event must always occur after discharge, noted a recent article at the National Law Review.

Whether the majority or minority of the patients you treat will wind up requiring transitional care management, you and your staff should strive to remain current on the codes that govern TCM so you won’t be upset by any surprises, going forward. Staying current on updates to the Current Procedural Terminology and learning about new TCM protocols will help ensure a timely flow of revenue in your organization.

Key Takeaway

  • The American Medical Association created two new codes for the Current Procedural Terminology database.
  • Code 99495 in the CPT has to do with your staff communicating with patients within two days following their discharge after a procedure of the least moderate complexity.
  • Code 99496 has to do with your communications with patients post-discharge in cases that are of high complexity.
  • You can follow up with patients and remain compliant with the new TCM code by communicating by email, phone or during an in-person meeting.
  • Communications with patients under transitional care management guidelines can then include giving additional educational materials, setting up referrals with specialists and taking care of follow-up time in the office.
  • A reduction in the number of hospital readmissions is a major goal of Transitional Care Management protocols.


About Stephen O'Connor

As a Director of Digital Marketing at Advanced Data Systems Corporation, Stephen spends his day's planning, writing, & designing resources for the modern healthcare professional. He has a strong affinity for snow crab legs, the ocean, and Rutgers Football.