When patients are discharged from the hospital, it’s easy to think that their medical issues are over and that they are back to proper health. Unfortunately, the reality is that plenty of patients need significantly more time to recover after check-out, and many can encounter complications once they have left the hospital. Much of the time, these patients’ primary care providers are not up to date with the procedures the patient has just undergone, meaning they are unprepared to treat the complications. As a result, nearly 20% of patients wind up back in the hospital within a month of discharge.
As a result, transitional care management (TCM) has slowly grown in popularity as a way of informing a patient’s usual doctor of all the treatments and services the patient has just received. This starts with the initial communication, represented by CPT codes 99495 and 99496, which stipulate that “an interactive contact must be made with the beneficiary and/or caregiver, as appropriate, within 2 business days following the beneficiary’s discharge to the community setting. The contact may be via telephone, email, or face-to-face.”
Under the rules outlined by the Medicare Learning Network, this initial communication can come from “you or clinical staff who have the capacity for prompt interactive communication addressing patient status and needs beyond scheduling follow-up care.” It is important to note, however, that the initial communication must fulfill incident-to guidelines. For this to happen, the primary physician must confirm and document that whichever clinical staff member made contact did so as a way of furthering integral patient treatment. This action must also fulfill requirements for being “reasonable and necessary,” so the patient must stand to be at risk from not receiving the transitional care. As always, thorough documentation is essential to completing this process and allowing patients to get the best level of care that they can.