Code Who can Payers PDCM Notes Documentation provide BCBSM service? MD and DO of BCBSM, N All Payers Description: Transitional care management Transitional Care any specialty, Medicare Description: Transitional care management services for patients whose medical and/or Management NP, PA, CNS, or (including services for patients whose medical and/or psychosocial problems require moderate CNM. Provider CPC+ psychosocial problems require moderate complexity medical decision making during does not need patients), complexity medical decision making during transitions in care from an inpatient hospital to have an Medicare transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation established Advantage, setting (including acute hospital, hospital, long-term acute care hospital), partial relationship Medicaid, rehabilitation hospital, long-term acute care hospital, observation status in a hospital, or with the Priority hospital), partial hospital, observation status skilled nursing facility/nursing facility, to the patient. Health (all in a hospital, or skilled nursing facility/nursing patient’s community setting (home, domicile, plans), facility, to the patient’s community setting rest home, or assisted living). Managed (home, domicile, rest home, or assisted Medicaid living). Health Documentation: Plans, Conditions of Payment: Date of visit The practitioner must communicate Date of interactive contact with the with the patient by the end of the beneficiary and/or caregiver Medicaid day on the second business day Electronic, telephone or face to face following the day of discharge. Place of service *”Incident Communication can be face-to-face, Complexity of medical decision making to” phone, or email. moderate. Documentation of any medical applies. Face–to-face visit is required within or psychosocial problems. Testing ordered, 14 days of discharge reviewed. Consultations with other The first face-to-face visit is not providers. Indication of number of reported separately, though E&M problems (established or new) services provided after the first to-face visit can be billed (with some Diagnosis: Report the diagnosis(s) for the exceptions) conditions requiring TCM services. General conditions the patient at the time of discharge. Medication reconciliation and management no later than the date of the face-to face visit
Code Who can provide service? Payers PDCM BCBSM Notes Documentation Transitional Care Management MD and DO of any specialty, NP, PA, CNS, or CNM. Provider does not need to have an established relationship with the patient. BCBSM, Medicare (including CPC+ patients), Medicare Advantage, Medicaid, Priority Health (all plans), Managed Medicaid Health Plans, Medicaid *”Incident to” applies. N All Payers Description: Transitional care management services for patients whose medical and/or psychosocial problems require moderate complexity medical decision making during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility, to the patient’s community setting (home, domicile, rest home, or assisted living). Conditions of Payment: The practitioner must communicate with the patient by the end of the day on the second business day following the day of discharge. Communication can be face-to-face, phone, or email. Face–to-face visit is required within 14 days of discharge The first face-to-face visit is not reported separately, though E&M services provided after the first to-face visit can be billed (with some exceptions) Description: Transitional care management services for patients whose medical and/or psychosocial problems require moderate complexity medical decision making during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility, to the patient’s community setting (home, domicile, rest home, or assisted living). Documentation: Date of visit Date of interactive contact with the beneficiary and/or caregiver Electronic, telephone or face to face Place of service Complexity of medical decision making moderate. Documentation of any medical or psychosocial problems. Testing ordered, reviewed. Consultations with other providers. Indication of number of problems (established or new) Diagnosis: Report the diagnosis(s) for the conditions requiring TCM services. General conditions the patient at the time of discharge. Medication reconciliation and management no later than the date of the face-to face visit
multipayer-g-and-cpt-billing-summary-and-documentation-july-25-2018.docx