• TCM / Progress Note

  • ALERT: BEFORE PROCEEDING WITH THIS PATIENT ENCOUNTER, PLEASE MAKE SURE THAT THE PATIENT HAS AN ACTIVE PRIOR AUTHORIZATION (PA) TO ENGAGE IN TCM

  • Note created on this date
     - -

  • Before continuing with this TCM/ Progress Note, check the "90 day Roster" on the TCM spreadsheets.  If the patient does not have an active Treatement Plan or requires an update, please complete a Treatment Plan first.  To access the Treatment Plan note, click on this LINK.  

    If a TCM/ Treatment Plan is not required or is currently active, then proceed with this TCM/ progress note!

  • What type of TCM is the patient participating in?*

  • ASAM SIX DIMENSIONAL CRITERIA SCALE ASSIGNED LEVEL OF CARE / ASAM CLINICAL SUMMARY

  • Dimension 1: Intoxication, Withdrawal, and Addiction Medications*
  • Dimension 2: Biomedical Conditions*
  • Dimension 3: Psychiatric and Cognitive Conditions*
  • Dimension 4: Substance Abuse Related Risks*
  • Dimension 5: Recovery Environment Interactions*
  • Dimension 6: Person Centered Considerations*

  • TCM TREATMENT PLAN / PROBLEM LIST

  • Target Date for Resolution of Problem #1
     - -
  • Target Date for Resolution of Problem #2
     - -
  • Target Date for Resolution of Problem #3
     - -

  • PROGRESS NOTE

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  • The patient has completed blood draw:*
  • Date of blood draw #1
     - -
  • Date of blood draw #2
     - -
  • Date of blood draw #3
     - -
  • The patient has been dispensed:*
  • Do you need to see assist notes?

  • TCM contacted and communicated with client to advise and remind client about upcoming medical appointments and a followup TCM appointment.

    TCM called ______ to gather resources for client to assist with ____________need.

    TCM followed up with community partner about client needs; TCM contacted and communicated with client.

    TCM consulted with therapist about client needs

    CM consulted with medical provider about client care and medical needs/compliance.

    TCM followed up with client and discussed resource options for _____

    TCM collaborated with community partner (may list agency/org /idividual name) regarding ________

    TCM worked with client one on one in office today regarding assessment and needs development and/or revision of treatment plan goals.

    TCM contacted and communicated with client regarding________

     

  • SIGNING and BILLING

  • Type of contact / Regular TCM*
  • Type of contact / Dual Diagnosis TCM*

  • I spent * minutes on the patient's case today. Today's encounter was   *   

  • This patient has Hepatitis C or carries a significant risk of having Hepatitis C. Hepatitis C is a chronic and complex health issue that has significant implications for the patient and for public health in general. Untreated, Hepatitis C will shorten a patient's lifespan by 20 years. Patients with untreated Hepatitis C will likely infect up to 20 other individuals in their lifetime. According to the CDC, Hepatitis C is an epidemic that's a major public health threat in the United States. It's also known as a "silent epidemic" because many people don't know they have it as they don’t have symptoms. Over the past 10 years, cases of Hepatitis C have more than doubled.

    The CDC recommends Hepatitis C screening and sexually transmitted disease (STD) screening particularly in high risk groups like patients with opioid use disorder. Diagnosing and treating Hepatitis C is a complex and time intensive process that requires multiple providers to ensure that care is coordinated and delivered efficiently. Case managers are a critical component as they facilitate this process.

  • Will you be billing for TCM Services with today's visit?*

  • Single Diagnosis TCM

    The patient had 4 contacts over the course of the calendar month. 2 contacts were "direct" or face to face and 2 contacts were "indirect" where service was provided on behalf of the patient.

  • Dual Diagnosis TCM (i.e., opioid use disorder plus Hep C)

    The patient had 5 contacts over the course of the calendar month. 3 contacts were "direct" or face to face and 2 contacts were "indirect" where service was provided on behalf of the patient.

     

  • CPT/ ICD 10 / DIAGNOSIS CODES FOR SINGLE DIAGNOSIS TCM*
  • CPT/ ICD 10 / DIAGNOSIS CODES FOR DUAL DIAGNOSIS TCM*
  • Was this visit part of the Russell County Hospital health initiative?*
  • Was the appointment conducted via telemedicine with the patient off-site?*
  • Which office location is this appointment attached to?*
  • Is the patient a resident with any of these sober living/ recovery facilities?*
  • DATE OF SERVICE*
     - -

  • Today's provider was {provider}.  The TCM supervisor is Lena Kline, LPCC-S (lena.kline@specialistsmat.com).

  • Should be Empty: