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Two new codes will help you get paid for managing a 99495 99496 99495 99496
patients transition from the inpatient to outpatient setting,
but they come with new expectations.
o Jacqueline Bloink, MBA, CHC, CPC-I, and Kenneth G. Adler, MD, MMM
Medical decision making of high complexity during the The face-to-face visit:
service period, complexity and timing
A face-to-face visit within seven days of discharge.
A face-to-face visit with the provider must
occur within seven to 14 calendar days after
records. If that is available to you, sign up. recommend the use of a paper or electronic
You should try to get access to the portal of template, as described earlier, for managing
every hospital in your community. Designate key steps in the transition of care workflow.
one or more staff to log on and download In addition, practices will need to develop
the information you need. If you are lucky a tracking system that reminds them to bill for
If your hospital
enough to be part of a health information these services at 30 days post-discharge. Solu- offers a physician
exchange in your community, you may need tions could range from creating a tickler file portal for access-
only one log-in versus separate log-ins for to creating a new appointment code for TCM ing patient records,
each facility. and running weekly reports to see which make sure youre
patients have reached the 30-day window. signed up.
All of this requires extra work, but most of
Figure out your office workflow
it is work that you have probably already been
Once you learn that the patient was dis- doing. Now you can be paid fairly for it, and
charged, you have precious little time to act. your patients will benefit. Good luck on your Figuring out what
Make sure your office has figured out what transitions of care! TCM tasks need to
should happen after you learn about the dis- happen, when, and
charge. Who will call the patient? Who makes 1. Current Procedural Terminology 2013: Standard Edition. by whom will pre-
Chicago: American Medical Association; 2012. pare your practice
sure additional records are obtained? Who
2. The Revolving Door: A Report on U.S. Hospital Readmis- to act promptly
makes the face-to-face visit appointment? We sions. Princeton, NJ: Robert Wood Johnson Foundation; when you learn that
February 2013. a patient has been
3. Medicare Program; Revisions to Payment Policies discharged.
Send comments to fpmedit@aafp.org, or Under the Physician Fee Schedule, DME Face-to-Face
Encounters, Elimination of the Requirement for Termi-
add your comments to the article at http://
nation of Non-Random Prepayment Complex Medical
www.aafp.org/fpm/2013/0500/p12.html. Review and Other Revisions to Part B for CY 2013 (Final
Rule). Federal Register. 2012;77(222):68978-68994.