In the healthcare system, Transitional Care Management (TCM) is essential to facilitating a seamless and well-coordinated transition for patients between various care environments. It's a healthcare methodology that guarantees patients receive appropriate medical attention as well as the assistance and direction they need during these changes.

TCM essentially lowers the risk of problems, guarantees continuity of care, and gives patients confidence to effectively handle their healthcare journey.

Eligibility Criteria To Qualify For Transitional Care Management

Transitional Care Management (TCM) assists patients throughout important transitional stages in their healthcare journey. The qualification process is specific and patient-centered, ensuring that individuals who require this assistance receive it.

• Medical complexity

The nature and complexity of a patient's medical condition are important considerations when establishing TCM eligibility. For example, a patient discharged from a cardiac bypass surgery with various medications and post-operative care instructions is likely to qualify for TCM codes and services due to the complexity of his/her condition.

• Risk of adverse events

TCM is ideal for patients who are more likely to experience complications or unpleasant outcomes after discharge. For example, an older patient who has a history of falls and has been released following fracture treatment. The risk of another fall, the necessity for rehabilitation, and the possibility of medication side effects make TCM vital.

• Coordination requirements

Patients who require coordination across several healthcare professionals or settings are eligible for TCM visits. For example, a cancer patient may need to go from the hospital to an oncology doctor and then to a radiation therapy clinic. TCM helps in organizing remote appointments, therapies, and follow-ups.

• Patient and caregiver education

Patient education is an important part of traditional Chinese medicine. Patients who require significant instruction about their ailment, drugs, or self-care are ideal candidates for TCM. For example, a newly diagnosed diabetic patient may require glucose monitoring, dietary changes, and insulin administration education.

• Post-discharge requirements

The post-discharge demands of a patient can also influence TCM qualification. TCM organized assistance would benefit a discharged patient who required home health care, medical equipment, or many follow-up consultations.

Overview Of Billing Codes for TCM

Billing for TCM treatments necessitates a detailed awareness of the specific CPT codes related to these services. The Transitional Care Management CPT code is critical to efficient invoicing and payment. Here are some frequent TCM CPT codes:

CPT Code: 99495

• Within 2 business days following release, communicate with the patient and/or caregiver via direct contact, phone, or email

• Make medical decisions with moderate complexity during the service term

• Face-to-face visit within 14 days of discharge from hospital

CPT Code: 99496

• Within 2 business days following release, communicate with the patient and/or caregiver via direct contact, phone, or email

• Complex medical decisions during the service period

• Face-to-face visit within 7 days of discharge

Rely On HealthArc’s TCM Platform For Maximum Reimbursement

Now that you understand what TCM is in healthcare and its importance, explore how HealthArc's digital platform can improve your transitional care operations. Our platform is built to the most recent CMS requirements, ensuring the best results for everyone involved. 

Please request a free demo to discover more about how we may help your business meet its long-term transitional care management objectives.

Let's work together to make healthcare easier and more efficient for everyone.