What Is TCM and Why It Matters for Hypertension

TCM is a Medicare program designed to ensure safe transitions from hospital or skilled nursing back into the community. Providers are reimbursed under two CPT codes:

• 99495 – Moderate complexity medical decision making, face-to-face visit within 14 days of discharge

• 99496 – High complexity medical decision making, face-to-face visit within 7 days of discharge

In addition, TCM requires:

• Contact with the patient or caregiver within 2 business days of discharge

• Medication reconciliation and care coordination activities

• Non-face-to-face support such as reviewing discharge summaries, ordering labs, and coordinating services

For hypertension, these elements ensure safe adjustment of therapy and monitoring in a critical post-discharge phase.

Benefits of TCM in Hypertension Care

• Medication Safety: Confirms that discharge prescriptions, such as new antihypertensives or dose adjustments, are accurate and followed.

• Reduced Readmissions: Early detection of poorly controlled blood pressure prevents avoidable ER visits.

• Integrated Care: Links hospital discharge planning with outpatient primary care and specialty follow-up.

• Patient Engagement: Provides reassurance and clear guidance during a high-risk period.

• Caregiver Support: Reinforces education for family members helping with monitoring and medication adherence.

Which Patients Benefit Most

TCM for hypertension is especially impactful for:

• Patients discharged after hypertensive crisis, stroke, or heart failure exacerbation

• Individuals with multiple chronic conditions (e.g., hypertension plus diabetes, CKD, or COPD)

• Seniors on complex medication regimens who are at risk of confusion or non-adherence

• Patients with limited access to transportation or poor follow-up history

What a 30-Day TCM Cycle Looks Like

1. Day 0 – Hospital Discharge – Patient discharged after hypertensive urgency treatment.

2. Day 1–2 – Initial Contact – Care coordinator calls within 48 hours to review meds and symptoms.

3. Day 3–14 – Face-to-Face Visit – Patient seen in clinic (within 7 days for high-risk cases).

4. Days 1–30 – Ongoing Support – Team arranges labs, monitors adherence, and communicates with specialists.

5. End of Period – Billing – Submit CPT 99495 or 99496 with documentation of contact, visit, and care coordination.

TCM in Action: A Case Example

Mrs. K, a 70-year-old woman, was discharged after a hospitalization for hypertensive emergency. A nurse coordinator contacted her within 48 hours, confirmed she filled her new prescriptions, and reviewed her home BP monitoring. Within 6 days, she was seen in the office, where her physician adjusted her regimen and arranged cardiology follow-up. Over the next month, her readings stabilized, and no readmission occurred.

Implementation Tips

• Use hospital alerts or ADT feeds to identify eligible patients at discharge.

• Standardize a 2-day outreach script to confirm medications, appointments, and warning signs.

• Train staff on TCM documentation and billing requirements (99495, 99496).

• Coordinate TCM with CCM or RPM programs for longer-term hypertension management beyond the 30-day period.

• Keep thorough time-stamped logs of patient contact and activities to ensure compliance.

Key Takeaway

For patients with hypertension, TCM is a vital safeguard during the high-risk post-discharge period. By providing structured outreach, timely follow-up, and coordinated care, practices can improve blood pressure control, reduce readmissions, and ensure smoother transitions back to the community.
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