Transition Care Management (procedural process not HEDIS measure)

Transition Care Management (TCM) includes services provided to a patient with medical and/or psychosocial problems. TCM service involve a transition of care from one of the following hospital settings:
      Inpatient acute care hospital
      Inpatient psychiatric hospital
      Long-term care hospital
      Skilled nursing facility
      Inpatient rehabilitation facility
      Hospital outpatient observation or partial hospitalization
      Partial hospitalization at a community mental health center

Evidence suggests that patients who see a doctor within 7-14 days of being discharged are significantly less likely to end up back in the hospital. This time frame may be more aggressive (shorter) with certain conditions and with different value-based contracts.

TIPS

The billable codes (not all inclusive) for the types of service include:
• 99495
     o Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
     o Medical decision making of at least moderate complexity during the service period
     o Face-to-face visit within 14 calendar days of discharge or sooner as noted above

• 99496
     o Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
     o Medical decision making of at least moderate complexity during the service period
     o Face-to-face visit within 14 calendar days of discharge or sooner at noted above

Source:
www.aafp.org
www.cms.org

Approved Quality Committee – 1/8/2020