2014 OMED. Joseph R. Schlecht, DO

Full text

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2014

OMED

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Today’s Presentation

 Intro to TCM codes

 CPT 2014 Editorial Revisions

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Chronic Care Coordination Workgroup

 July 19 Proposed Rule for 2012 Medicare Physician

Payment Schedule – CMS requested that RUC review all of E/M to ensure that care coordination was

appropriately valued

 July 29, 2011 Meeting with Donald Berwick, MD (CMS

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Chronic Care Coordination Workgroup

 Specialty society comments to CMS and AMA’s

message was consistent: a re-review of E/M would not be productive and would not address CMS stated

goals:

 Incentivize care coordination and improve health care

delivery to patients with chronic disease

 Improve payments to primary care to “shore up primary

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Chronic Care Coordination Workgroup

 Informed Doctor Berwick that the CPT Editorial Panel

and the RUC would engage in an effort to ensure that the coding and valuation of care coordination are

appropriate.

 Created the Chronic Care Coordination Workgroup

(C3W) in August 2011.

 David Hitzeman, DO (AOA RUC Representative) was

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Chronic Care Coordination Workgroup

The charge to the C3W was to provide strategic

direction to CPT and RUC to address the adequacy

of coding and valuation of care coordination services

and prevention/ management of chronic disease.

A request to CMS to immediately implement

payment for anticoagulant management, telephone

calls, team conferences and patient education was

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Chronic Care Coordination Workgroup

 In Fall 2011, the C3W recommended that codes for

transitional care management and complex chronic care management be developed for CPT 2013.

 CPT Editorial Panel completed this work in May

2012 (CPT workgroup co-chaired by 2 DOs and 1 MD Family Physician).

 Codes 99495 and 99496 for Transitional Care

Management (TCM) were added to the CPT code set in 2013.

 Codes 99487, 99488 and 99489 for Complex

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Transitional Care Management

Services (TCM)

The transition in care

is

from:

an inpatient hospital

setting

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Transitional Care Management

Services (TCM)

 Codes 99495, 99496:

 Are reported once per patient within 30 days of

discharge

 Are selected based on medical decision making and

the date of the first face-to-face visit

 May only be reported by one individual

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Transitional Care Management

Services (TCM)

● 99495 Transitional Care Management Services

with the following required elements:

Communication (direct contact, telephone,

electronic) with the patient and/or caregiver

within 2

business days of discharge

Medical decision making of at least moderate

complexity during the service period

Face-to-face visit, within

14 calendar days of

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Transitional Care Management

Services (TCM)

● 99496 Transitional Care Management Services with the following required elements:

 Communication (direct contact, telephone, electronic)

with the patient and/or caregiver within 2 business days of

discharge

 Medical decision making of high complexity during the

service period

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Transitional Care Management

Services (TCM)

 Regarding the required face-to-face visit, CPT states:

“The first face-to-face visit is part of the TCM service and

not reported separately. Additional E/M services

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Transitional Care Management Services

- 2014 Editorial Revisions

 Expands applicability to new patients

Transitional Care Management Services

►Codes 99495 and 99496 are used to report transitional care management services (TCM). These services are for a new or established patient whose medical and/or psychosocial

problems require moderate or high complexity medical

decision making during transitions in care from an inpatient hospital setting…

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Transitional Care Management Services -

2014 Editorial Revisions

 Clarify separately reported E/M services should be

provided on subsequent dates

►TCM requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames. The first face-to-face visit is part of the TCM service and not reported separately. Additional E/M services provided on subsequent dates after the first face-to-face visit may be

reported separately. TCM requires an interactive contact with the patient or caregiver…

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Transitional Care Management Services -

2014 Editorial Revisions

 Specify the discharge services may not constitute the

required face-to-face visit

►Only one individual may report these services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within the 30 days. The same

individual may report hospital or observation discharge services and TCM. However, the discharge service may

not constitute the required face-to-face visit. The same…

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Transitional Care Management Services –

2014 Editorial Revisions

 Clarify the same individual should

not report TCM during the postop period the individual reported.

►Only one individual may report these services and only once per patient…

However, the discharge service may not constitute the required face-to-face visit. The same individual should not report TCM services provided in the

postoperative period of a service that the individual reported.◄

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Transitional Care Management

Services (TCM)

Q: TCM codes require interactive contact within two

business days. What if I can’t reach the patient or

caregiver within this time frame?

A: Refer to the Transitional Care Management

Coding Tip in the CPT code set…..

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Transitional Care Management

Services

Coding Tip

The required contact with the patient or caregiver, as

appropriate, may be by the physician or qualified health care professional or clinical staff. Within two business days of

discharge is Monday through Friday except holidays without respect to normal practice hours or date of notification of discharge. The contact must include capacity for prompt

interactive communication addressing patient status and needs beyond scheduling follow-up care. If two or more separate attempts are made in a timely manner, but are

unsuccessful and other transitional care management criteria are met, the service may be reported.

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Transitional Care Management

Services (TCM)

Transitional Care Management Forms can be used to track the TCM Services.

Examples:

 American Academy of Family Physicians  American College of Physicians

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Transitional Care Management

Services (TCM)

Other Resources

 Frequently Asked Questions about Billing Medicare

for Transitional Care Management Services

http://www.cms.gov/Medicare/Medicare-Fee-for-

Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf

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