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What counts as a transition of care?
- Any time the patient is move from an inpatient setting back to their community setting
- Inpatient status may include an ED visit, inpatient hospital visit or inpatient mental health facility
- Community setting may include a patient’s home, assisted living facility or even a long term care facility
Many time a post-discharge Transitional Care Management Service can be integrated into an existing CCM program.
What are the CPT Codes for billing?
99495 ~$164 for non-facility setting ~$135 for facility setting
- Communication (direct contact, telephone, electronic) with patient/caregiver within 2 business day of d/c
- Medical decision making of at least moderate complexity during the service provided
- Face-to-face visit within 14 calendar days of discharge
- Can be in office, in the home or other location of residence
99496 ~$231 for non-facility setting ~$197
- Communication within 2 business day of d/c
- Medical decision make on high complexity during service period
- Face-to-face visit within 7 calendar days of d/c
- Can be in office, in home or other location of residence
What services a Consultant Pharmacist could offer to patients undergoing Transitions of Care?
- Medication reconciliation
- Communication with patient/caregiver
- Access to care and services need by the patient/their family
- Review need for follow-up tests and treatments
- Assist in scheduling appointments
- May be used on new or established patients
How can you put a program like this together?
A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could provide the primary touch point for a patient in the 48 hours post discharge.
This consultant would need to be engaged in a financial relationship with the physicians office and generally needs to be under a collaborative practice agreement, though not exclusively necessary.
Lesson 7 in the E-course at the Pharmapreneur Academy is ALL about the CCM and TCM codes for billing for pharmacist services!
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