2014 OMED. Joseph R. Schlecht, DO

Transcription

1 2014 OMED Joseph R. Schlecht, DO

2 Today s Presentation Intro to TCM codes CPT 2014 Editorial Revisions External Documentation Resources Q&A

3 Chronic Care Coordination Workgroup July 19 Proposed Rule for 2012 Medicare Physician Payment Schedule CMS requested that RUC review all of E/M to ensure that care coordination was appropriately valued July 29, 2011 Meeting with Donald Berwick, MD (CMS Administrator) Doctors Robert Wah (AMA Board Trustee), Peter Hollmann (Chair of CPT) and Barbara Levy (Chair of RUC)

4 Chronic Care Coordination Workgroup Specialty society comments to CMS and AMA s message was consistent: a re-review of E/M would not be productive and would not address CMS stated goals: Incentivize care coordination and improve health care delivery to patients with chronic disease Improve payments to primary care to shore up primary care and nursing

5 Chronic Care Coordination Workgroup Informed Doctor Berwick that the CPT Editorial Panel and the RUC would engage in an effort to ensure that the coding and valuation of care coordination are appropriate. Created the Chronic Care Coordination Workgroup (C3W) in August David Hitzeman, DO (AOA RUC Representative) was a member of the workgroup

6 Chronic Care Coordination Workgroup The charge to the C3W was to provide strategic direction to CPT and RUC to address the adequacy of coding and valuation of care coordination services and prevention/ management of chronic disease. A request to CMS to immediately implement payment for anticoagulant management, telephone calls, team conferences and patient education was submitted to CMS on October 3, CMS declined to implement this recommendation.

7 Chronic Care Coordination Workgroup In Fall 2011, the C3W recommended that codes for transitional care management and complex chronic care management be developed for CPT CPT Editorial Panel completed this work in May 2012 (CPT workgroup co-chaired by 2 DOs and 1 MD Family Physician). Codes and for Transitional Care Management (TCM) were added to the CPT code set in Codes 99487, and for Complex Chronic Care Coordination (CCCC) were also added to CPT 2013

8 Transitional Care Management Services (TCM) The transition in care is from: an inpatient hospital setting partial hospital (psych) observation status in a hospital skilled nursing facility/nursing facility To the patient s community setting: home domiciliary rest home or assisted living 8

9 Transitional Care Management Services (TCM) Codes 99495, 99496: Are reported once per patient within 30 days of discharge Are selected based on medical decision making and the date of the first face-to-face visit May only be reported by one individual 9

10 Transitional Care Management Services

11 Transitional Care Management Services (TCM) Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge 11

12 Transitional Care Management Services (TCM) Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge 12

13 13

14 Transitional Care Management Services (TCM) Regarding the required face-to-face visit, CPT states: The first face-to-face visit is part of the TCM service and not reported separately. Additional E/M services provided on subsequent dates after the first face-to-face visit may be reported separately.

15 Transitional Care Management Services Editorial Revisions Expands applicability to new patients Transitional Care Management Services Codes and are used to report transitional care management services (TCM). These services are for a new or established patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting 15

16 Transitional Care Management Services Editorial Revisions Clarify separately reported E/M services should be provided on subsequent dates TCM requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames. The first face-to-face visit is part of the TCM service and not reported separately. Additional E/M services provided on subsequent dates after the first face-to-face visit may be reported separately. TCM requires an interactive contact with the patient or caregiver 16

17 Transitional Care Management Services Editorial Revisions Specify the discharge services may not constitute the required face-to-face visit Only one individual may report these services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within the 30 days. The same individual may report hospital or observation discharge services and TCM. However, the discharge service may not constitute the required face-to-face visit. The same 17

18 Transitional Care Management Services 2014 Editorial Revisions Clarify the same individual should not report TCM during the postop period the individual reported. Only one individual may report these services and only once per patient However, the discharge service may not constitute the required face-to-face visit. The same individual should not report TCM services provided in the postoperative period of a service that the individual reported. 18

19 Transitional Care Management Services (TCM) Q: TCM codes require interactive contact within two business days. What if I can t reach the patient or caregiver within this time frame? A: Refer to the Transitional Care Management Coding Tip in the CPT code set.. 19

20 Transitional Care Management Services Coding Tip The required contact with the patient or caregiver, as appropriate, may be by the physician or qualified health care professional or clinical staff. Within two business days of discharge is Monday through Friday except holidays without respect to normal practice hours or date of notification of discharge. The contact must include capacity for prompt interactive communication addressing patient status and needs beyond scheduling follow-up care. If 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. 20

21 Transitional Care Management Services (TCM) Transitional Care Management Forms can be used to track the TCM Services. Examples: American Academy of Family Physicians American College of Physicians 21

22 Transitional Care Management Services (TCM) Other Resources Frequently Asked Questions about Billing Medicare for Transitional Care Management Services Service-Payment/PhysicianFeeSched/Downloads/FAQ- TCMS.pdf 22

23 Questions?