Transitional Care Management - Time to Get It Right!

We can all agree that the face of medicine is changing. How care models are designed is essential to a successful, measurable healthcare quality outcome. In the past, providing care for a chronically ill patient with multiple comorbidities and frequent jumps between an acute care setting and their community often meant a great deal of behind-the-scenes work for healthcare professionals, with very little revenue reimbursement potential. In 2013, CPT® introduced two new codes for transitional care management (TCM) that allowed healthcare providers to capture the significant amount of work involved in managing these complex cases. Since then, however, there has been confusion about when these services can be performed, what needs to be documented, and how to code claims. Let’s clear up the confusion once and for all.

To properly report these services, we first need to understand the TCM codes. The overall goal of TCM is to reduce the number of subsequent readmissions to an acute care facility by giving patients and their caregivers the knowledge and skills to address healthcare needs as they arise. These services utilize an evidence-based care coordination approach with the goal of streamlining care and addressing the most pressing needs of the patient at any given time.