these are calendar days, not business days. if the first faceto face encounter occurs later than 14 calendar days after discharge, the tcm service is not billable. How Often Can TCM Be Billed? the tcm service begins on the date of discharge and continues for the subsequent 29 days. during this time, only one physician/nPP or group can report tcm. the cms fact sheet contains instructions for situations when the patient is readmitted during the 30-day tcm period. What Services Can Be Billed Together with TCM? cms allows the same physician or nPP to report both hospital or observation discharge and tcm. however, the tcm faceto face visit cannot occur on the same day as discharge management. the physician or nPP who provides tcm can also bill for any reasonable and necessary e/m services over and above the required tcm face-to-face visit. the physician or nPP cannot bill for tcm if any of the 30- day tcm period falls within the global period of a procedure performed by that physician or nPP. finally, care plan oversight (g0181–g0182) and end stage renal disease services (90951–90970) cannot be reported during the tcm period. What Documentation Is Required For TCM? cms states that the provider must document the following, at a minimum: • date of discharge • date of interactive contact • date of face-to-face visit • complexity of mdm in addition to these minimum requirements, providers should follow standard medical record documentation practices. in particular, an auditor should be able to determine, based on medical record review, what specific services the physician/nPP and clinical staff provided for the patient and why they were medically necessary. Resources for a summary of medicare rules regarding tcm, you can download the “transitional care management services fact sheet” from the cms website at: 36 hbma billing • november.december.2013 www.cms.gov/outreach-and-education/medicare-learningnetwork mln/mlnProducts/mln-Publ icat ionsitems/ icn908628.html additionally, you can find valuable information about tcm in the april 2013 and july 2013 issues of CPT® Assistant. at the time this article was written in late summer 2013, cms had not yet manualized its tcm requirements. however, you can expect to see tcm included in the medicare claims Processing manual via a transmittal at a future date. Jackie Miller, RHIA, CCS-P, CPC, PCS, is vice president of product development at Coding Strategies, Inc. (Transitional Care Management continued) Billing Update! We are working hard to enhance Billing to ensure that it meets the needs of our membership, but need your input. as you see, each issue has been greatly expanded to include topics that impact our industry and businesses. do you have a suggestion for a future column in hbma Billing? is there a specific topic that you would like to see covered by industry experts? We want to hear from you. We have created a new email address: billing@hbma.org. Please feel free to send any comments about Billing to this address. are there particular subjects that you would like published in future issues? do you have any comments about past articles? Please offer suggested topics for Sound Off! as well. We are open to any and all suggestions. thank you! SECURITY
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