Melissa Gaines MD Assistant Professor October 4 2013 Purpose Care Transitions Care Transitions Care Transitions Barriers to Safe Transitions Case Example 56 yo female with CAD CHF and ID: 779098
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Slide1
Coordination of Care: How to Implement in Practice
Melissa Gaines MD
Assistant Professor
October 4, 2013
Slide2Purpose
Slide3Care Transitions
Slide4Care Transitions
Slide5Care TransitionsBarriers to Safe Transitions
Slide6Case Example
56 yo female with CAD, CHF and BiVAICD
presents for hospital follow-up 6 days after dismissal
Discharge summary is not available
She presented with syncope after taking nitroglycerin for chest pain.
She remained hypotensive and Valsartan was discontinued.She needs scheduled for her BiVAICD battery replacementShe reports increased anxiety because she is losing her medical card
Slide7Case Example
LabsTSH 1.36FT4 2.3Chol 147
LDL 75
HDL 33
TG 194
Troponin <0.01 x3RadiologyCT Head negativeCXR emphysematous changes
Slide8Case ChallengesNo discharge summary
Potential missed intervention with battery change in BiVAICDMedication change
CHF patient with syncope
Insurance change
Slide9Care Coordination CodesTransitional Care Management (TCM) Codes
9949599496
Slide10TCM CodesOnce in a 30 day period after discharge
Acute hospitalRehabilitation hospitalLong term acute care hospital
SNF/NF
Slide11TCM CodesRequirements
Initial patient/caregiver contactPhone
Electronic
Face-to-face
Within
2 business days after dischargePhysician, mid-level, licensed clinical staff Capacity to address medical concerns related to care of the patient
Slide12TCM Codes99495
Contact 2 business days
Face-to-face visit within 14
calendar
days
Medication reconciliation at time face-to-faceMDM moderate complexity (level 4)Medicare reimbursement
$154.52
Slide13TCM Codes99496
Contact 2 business daysFace-to-face visit within
7
calendar
days
Medication reconciliation at time face-to-faceMDM high complexity (level 5)
Medicare reimbursement$218.26
Slide14TCM Codes
Slide15TCM CodesDocumentation
Must document initial contact occurred
2 separate attempts in a timely manner if unsuccessful
MDM only component required
Slide16TCM CodesBillingBill TCM code at day 30 from discharge
Only 1 TCM code per 30 daysRegular E/M codes for return visits
Slide17Team Based CareKU Adult Medicine Providers
Debbie APRN
Lisa RN
Dr. Gaines
Slide18Call arrives for hospital follow-up appointment
Front Office
Confirm date discharge & record appointment scheduled within 7 days with PCP or APRN
Send list of
pts
to nurse at end of day
NursingPatient phoned next morning to review meds, order labs, answer questionsPull discharge med reconciliation EMR updatedDay 1Day 2Day 3-7ProviderPatient arrives for appointment with appropriate pre-visit planning & documentation availableEMR codes 9949599496See screen shots
Slide19Receive Discharge documents
Provider
A
ppointment scheduled within 7 days with PCP or APRN
Forward documents to RN
Nursing
Patient phoned review meds, order labs, answer questionsPull discharge med reconciliation EMR updatedDay 1Day 2Day 3-7ProviderPatient arrives for appointment with appropriate pre-visit planning & documentation availableBill9949599496Nursing
Slide20EMR DocumentationPre-visit Planning
Auto text phrasingPatient's hospital records with history, d/c summary, labs, and x-rays were requested and reviewed.
Time spent face-to-face
25 Minutes Level 4 (MDM)
40 Minutes Level 5 (MDM)
Slide21EMR Documentation
Slide22EMR Documentation
Contact
Meds
Slide23TCM Code ResultsJanuary 1-July 30
49 TCM visitsPayment for 42 visits
Slide24Insurance and TCMPaid
Aetna Coventry Medicare
Humana
Advantra
Unpaid
BCBSRequesting notes and explanation of code
Slide25Insurance and TCM
Charge
Average Reimbursement
Highest Reimbursement
99495 (14 day)
$270
$140$218.6099496 (7 day)$385$205$327.25
Slide26ConclusionCare transitions are valued with higher reimbursement
Proper documentation of initial contact is essentialVisit must be within 7-14 days
after discharge
Slide27Referenceshttp://www.acponline.org/running_practice/payment_coding/coding/tcm_codes.htm
http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFAQ.pdf
Slide28Questions?