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Making sense of the new transitional care codes. The government wants to reduce the rehospitalization rate among Medicare patients, and that could mean a bottom line boost for many primary care practices. CMS estimates that about 7% of the funds earmarked for the two codes for 2. Rules for private payers may differ. Long- term savings expected.

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Although paying for TCM will mean additional outlays from Medicare over the short term, both CMS and medical groups expect that it will produce savings over the long term, says Shari Erickson, MPH, director of regulatory and insurer affairs for the American College of Physicians (ACP). The 2. 01. 3 CPT codes also include three new codes covering complex chronic care coordination (CCCC) services. CMS did not include the codes in its 2. Medicare will not yet reimburse for them. Types of covered services for staff members (under the physician’s direction). The older code, however, is worth 4. RVUs, or between $1.

Moreover, she says, the face- to- face visit in the newer codes is not “exam- intensive.”. It’s more of, ? How can I help you better manage this disease to keep you from going back into the hospitals?’ ” she says. In practice, however, Seyfried says the primary care physician (PCP) is the most likely to submit the bill. They just want to do their procedure and be done with the patient.”.

According to Erickson, CMS’ initial draft of the codes did not require a face- to- face visit. Now we’re contacting . It’s great public relations. The patients love it, and it gives them the chance to ask, .

It is available on the organization’s Web site at www. And is it even the hospitalist’s responsibility to notify the PCP? I don’t know how that’s going to be resolved.”.

Seyfried says she has fielded calls from PCPs asking how they will know when their patients are discharged. The patient is hospitalized frequently due to his multiple comorbidities.

Our office saw him for a follow- up visit within a week of discharge; it was an extended visit of an established patient (CPT 9. Our office received $1.

Medicare participation in Connecticut. The 2. 01. 3 rate would be $1. The physician placed a brief telephone call to his house within 2 business days of the hospital discharge and had a discussion with one of his family caregivers concerning the plan of care, including diet, medication, blood glucose, and medical follow- up appointments. The medical decision- making level was deemed high complexity due to his several comorbidities. CPT code 9. 94. 96 was used.

Reimbursement was $2. Case history 2: CCCCPatient: An 8. History: December 1.

She woke up after a brief period of unconsciousness. She declined to go to the hospital and instead had a friend drive her to my office. After a brief examination, I insisted she go to the emergency department (ED) for a computed tomography scan and further evaluation. A routine chest x- ray performed because of the syncope, however, revealed a 3- cm right upper lobe mass not present on her last chest x- ray a year earlier. She was admitted to the hospital for observation and underwent a needle biopsy of the lung mass. Further testing was scheduled, along with a referral to a thoracic surgeon. The patient returned to my office January 7 with a new cough and was treated for bronchitis.

I ordered a chest x- ray to exclude pneumonia or a delayed pneumothorax from the recent needle biopsy. A call to the patient confirmed this fact, and one of our clinical staff members spoke with the pulmonary function lab and again with the patient to get her spirometry test rescheduled. These calls took 1.

I also called the surgeon to update him on the patient’s acute bronchitis and the need to delay things a bit. This call lasted 3 minutes. We spoke for 5 minutes. We spoke for 5 minutes. The same day, one of her daughters came to the office to discuss her mother’s case. We discussed the respiratory symptoms, whether her illness could be influenza, and the possible treatments of the cancer.

I spent 1. 0 minutes with the daughter. Once again, her spirometry test was rescheduled. We also discussed her visit with the surgeon. I spoke to her for 1. The Centers for Medicare and Medicaid Services considers the included services to be bundled services and thus will not pay for them separately, but it is studying them for possible separate implementation in the future.

The reporting individual provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs, and activities of daily living.”Specific applications of the codes: 9. Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with no face- to- face visit, per calendar month. Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with one face- to- face visit, per calendar month. Complex chronic care coordination services; each additional 3. Care coordination activities performed by clinical staff members may include. Patient and/or family/caretaker education to support self management, independent living, and activities of daily living.