You’ve likely heard about new codes for transitional care management (TCM) services that became effective Jan. 1, 2013. If you’ve had questions about the required elements, the documentation needed and more, the ISMA now has a tool to help answer those questions.

To help you through the learning curve, the ISMA staff developed an ISMA Coding Resource document on transitional care management services. While not all inclusive, the document may save you some time and phone calls.

“It’s important to note these codes do require face-to-face visits,” said Gloria Kirkham, CPC, COBGC, ISMA practice advisor.

Some other key points about the new

TCM codes are:

• Payment for TCM codes is not restricted to specific specialties. Qualified non-physician practitioners, such as physician assistants, clinical nurse specialists and certified nurse midwives, may provide the services – unless limited by scope of practice.
• New TCM codes can be used for established patients unless payer policy has other specific guidelines.
• Medicaid does not pay for these new codes but Medicare does.
• Physicians may bill for the discharge code and the TCM code if both services were provided, but not on the same date of service.
• Coverage for TCM codes begins on day of discharge and continues for the next 29 days.
• Physicians may not report more than one TCM code per patient within 30 days of discharge

“You are encouraged to continue to refer to your CPT book and to follow each payer’s policy because these are still developing codes,” said Kirkham. “As for commercial payers, some will pay for the new codes and others will not. Check with your top commercial payers to determine if they will reimburse you for the TCM codes.”

The ISMA coding resource will be updated and revised as new information becomes available. Find the Transitional Care Management Coding Resource tool on the ISMA website.