specialties for primary care will receive the largest increase in the payment under a new fee for the management a Medicare beneficiary to care when the beneficiary is discharged from a hospital outpatient observation, hospital, mental health community center, partial hospitalization services or a SNF. While announcing its new policy, CMS has recognized that the extensive care coordination is not face-to-face provided by doctors and nurses was not considered in the existing payment schedule for E / M (Evaluation and Management) services. The new directive will provide payments to physicians and other health professionals to coordinate transitions to care for Medicare beneficiaries after they have been discharged from hospitals nursing / skilled facilities for assisted living facilities or their homes. The new rule is effective from 1 January 2013.
The new codes: 99495 and 99496
CMS has a clear goal to introduce these new codes for the management of transition care services (TCM). They are intended to prevent emergency room visits and re-hospitalizations during the first 30 days after discharge. In addition to the basic medical that would billing for most of these services, specialists providing necessary services can also charge these new CPT codes.
the requirements of the MTC
- 99495, TCM: communication (direct contact , phone, e) with patient and / or caregiver within two days of discharge; Medical decision-making at least moderate complexity during the period of service; face-to-face visit within 14 calendar days after discharge.
- 99496, TCM: communication (direct contact , phone, e) with the patient and / or caregiver within two days of discharge; highly complex medical decisions during the period of service, face-to-face visit within seven calendar days after discharge.
E 'be noted that both of these codes require communication with the patient and / or provider of care within two days working exhaust, plus a visit face to face with the patient within a given period of time. Decision on drugs and management must be made at least the day of the visit face to face.
Non-face-to-face care coordination can be made by the supplier and / or licensed clinical staff under his / her direction. However, the visit face to face must be performed by the same supplier with staff assistance.
Price list for New TCM Codes
The values assigned to new codes of TCM are 4.82 relative value units to 99495 code and 6.79 units relative value for Code 99496. provided that Congress prevent the imminent 26.5% cut in payments to physicians and maintains the current conversion factor of $ 34.0066, the payments for these codes will be:
In the non-structure (doctor's office) settings:
- 99495 Code: $ 163.91
- 99496 Code: 230.0 $
In structure (outpatient hospital) settings:
- 99495 Code: $ 134.67
- 99496 Code: $ 197.58
These codes can only be billed after at least 30 days after discharge, when it is completed the service period. The primary incentive payments careful not to be added to these amounts.
Points to keep in mind
- Be sure to charge only for the post-discharge patients requiring moderate or high complexity of medical decision making .
- The initial face-to-face visit does not have to be in the office.
- The first visit face to face with the patient after discharge is part of TCM service and can not be reported separately. E / M services offered in addition can be reported separately.
- documentation guidelines for E / M are not applicable to these codes. Providers so they must take account of how they would like to document not face to face services that are required by codes. The complexity of medical decision making, the timing of the first communication after discharge, and the date of the visit face to face must be documented.
- Providers can use these codes to bill for new as well as established patients.
- Exhaust services and the visit face-to-face request with the TCM code can not be scheduled on the same day. However, the same doctor who bills for waste services can also bill for TCM services. Importantly, the same professional can not report the MTC services provided during a post-surgery period for a service with a period of global, since it is clear that these services are already included in the fee for the procedure below.
- A very important point to remember is that only a professional can bill for TCM services during the 30 days after discharge of a patient. The first professional to invoice for the service to only receive a refund. Therefore, traders should necessarily communicate with the patient and / or caregiver, and exhaust doctor to be clear about who will be the management of TCM services.
- for TCM practitioners may charge only once in the 30 days after discharge, even if the patient seems to be downloaded 2 or more times within the 30 day period.
- providers can not bill for other care coordination services (such as codes floor of 99,339 supervisory assistance, 99340, 99374-99380) provided during the period TCM.
0 Komentar