Q: Our office is having a difficult time reaching patients within the required two business days from discharge for transitional care management (TCM) codes. Will this preclude us from billing the codes when all of the other criteria are met?
A: TCM services require that you make direct contact with the patient or the patientâs caregiver within two business days of their discharge from the hospital or other facility. However, as long as you attempt to make contact, that counts for Current Procedure Terminology (CPT) billing purposes, and youâre eligible to submit the claim.
This information is included in the âCoding Tipâ directly following the TCM codes (99495 and 99496) in the CPT codebook. It explains what to do if you arenât able to fulfill the codesâ direct-contact requirement. Specifically, it reads:
âIf two or more separate attempts are made in a timely manner but are unsuccessful and other transitional care management criteria are met, the service may be reported.â
Since the coding tip seems to only be focused on the use of modifier 54 in a post-op period, itâs easy to miss this piece of information. However, it can be very helpful when trying to bill these codes.
However, make sure you check with your local Medicare Administrative Contractor (MAC) to see whether they adhere to the CPT policy. While this rule covers you for commercial payers, itâs important to remember that Medicare Learning Network fact sheet 908628 states, âFor Medicare purposes, attempts to communicate should continue after the first two attempts in the required two business days until they are successful.â