You’re Already Doing The Work, So Why Not Get Paid For It?

Three high-value services family physicians are likely providing but not always billing for are Transitional Care Management, Chronic Care Management, & Advance Care Planning.

Transitional Care Management (TCM) addresses the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy.

It is safe to assume that all physicians had provided the service at some point over the year. In many cases, they likely billed these services as an office visit (CPT code 99214) instead of a transitional care management service (CPT code 99495). The difference between the two codes is 0.6 work RVUs or approximately $57.32.

TCM Coding:
The two CPT codes used to report TCM are:
1) 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge
2) 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge