2020 CMS Boosts Transitional Care Management Pay, Removes Edits

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2020 CMS Boosts Transitional Care Management Pay, Removes Edits

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Transitional care management services

When you’re helping patients successfully transition from the hospital, SNF, or rehab, you can capture your non face-to-face services care coordination with Transitional Care Management codes. To encourage you to use these codes more often, CMS 2020 is making them more lucrative and less burdensome.

Hospital re-admissions, deaths, and healthcare costs are all decreased with post-discharge Transitional Care Management (TCM) care services. Unfortunately, TCM services are often underutilized due to their high administrative burden and low physician fee.

The CMS 2020 Physician Fee Schedule (PFS) final rule boosts Transitional Care Management fees and allows concurrent billing with several previously unallowed CPT codes. Implement these tips in to your practice to start increasing your billing in 2020.

Expect More Pay for Transitional Care Management Services

Transitional Care Management services were adopted in January 2013 for the management of transition from acute care or certain outpatient stays to a community setting. These services include a face-to-face visit, once per patient within 30 days post-discharge.

CMS increased the payment for the two Transitional Care Management CPT codes, effective Jan. 1, 2020:

  • 99495 (Moderate) – 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. Increased from 2.11 to 2.36 work RVUs.
  • 99496 (Complex) – 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. Increased from 3.05 to 3.10 work RVUs.

Bill Transitional Care Management with Additional Services That CPT Disallows

The 2020 Physician Fee Schedule reduced some billing restrictions. Originally, CMS had found 57 codes duplicative with TCM services.

Many of these codes were either bundled, noncovered by Medicare, or invalid for Medicare payment purposes. 14 of the payable codes have now been opened as separately payable along medically necessary TCM.

CMS “determined that the 14 codes, when medically necessary, may complement TCM services rather than substantially overlap or duplicate services,” according to the Final Rule. “We also believed removing the billing restrictions associated with the 14 codes might increase use of TCM services.”  

 Along with medically necessary TCM, per CMS, you may now also bill the following codes:

Prolonged Services without Direct Patient Contact

  • 99358 – Prolonged E/M service before and/or after direct patient care; first hour; non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service
  • 99359 – Prolonged E/M service before and/or after direct patient care; each additional 30 minutes beyond the first hour of prolonged services

Rationale: “For example, CPT code 99358 would allow the physician or other qualified healthcare professional extra time to review records and manage patient support services after the face-to-face visit required as part of TCM services,” states CMS.

Note: CPT 2020 guidelines still indicate this bundle is not allowed.

Home and Outpatient International Normalized Ratio (INR) Monitoring Services

  • 93792 – Patient/caregiver training for initiation of home INR monitoring
  • 93793 – Anticoagulant management for a patient taking warfarin; includes review and interpretation of a new home, office, or lab INR test result, patient instructions, dosage adjustment and scheduling of additional test(s)

Note: CPT 2020 guidelines still indicate this bundle is not allowed.

End-Stage Renal Disease Services (patients who are 20+ years)

  • 90960 – ESRD related services monthly with 4 or more face-to-face visits per month; for patients 20 years and older
  • 90961 – ESRD related services monthly with 2-3 face-to-face visits per month; for patients 20 years and older
  • 90962 – ESRD related services with 1 face-to-face visit per month; for patients 20 years and older
  • 90966 – ESRD related services for home dialysis per full month; for patients 20 years and older
  • 90970 – ESRD related services for dialysis less than a full month of service; per day; for patient 20 years and older

Note: CPT 2020 guidelines still indicate this bundle is not allowed.

Analysis of Data

  • 99091 – Collection and interpretation of physiologic data

Complex Chronic Care Management Services

  • 99487 – Complex Chronic Care with 60 minutes of clinical staff time per calendar month
  • 99489 – Complex Chronic Care; additional 30 minutes of clinical staff time per month

Note: CPT 2020 guidelines still indicate this bundle is not allowed.

Care Plan Oversight Services

  • G0181 – Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities within a calendar month; 30+ minutes
  • G0182 – Physician supervision of a patient receiving Medicare-covered hospice services (Pt not present) requiring complex and multidisciplinary care modalities; within a calendar month; 30+ minutes

Report Chronic Care Management Codes Plus TCM Per CMS

Chronic Care Management (CCM) services already include certain Transitional Care Management services when performed during the same month, including following up with patients after discharge from inpatient and some outpatient visits, so billing TCM services at the same time as chronic care management hasn’t been allowed.

Change: Effective Jan. 1, 2020, you will be able to bill these two non-complex chronic care management CPT codes concurrently with Transitional Care Management services:

  • 99490 – Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional (QHP), per calendar month
  • 99491 – Chronic care management services, provided personally by a physician or other QHP, at least 30 minutes of physician or other QHP time, per calendar month.

Document: Read the CMS Physician Fee Schedule Final Rule at https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

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