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TCM includes services provided to a patient whose 
medical and/or psychosocial problems require moderate or 
high-complexity medical decision making during transitions 
in care from an inpatient hospital setting (including acute 
hospital, rehabilitation hospital, long-term acute care hospital), 
partial hospital, observation status in a hospital, or skilled 
nursing facility/nursing facility, to the patient’s community 
setting (home, domicile, rest home, or assisted living).

The following link provides answers to FAQs and the second link provides a documentation template:

http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFAQ.pdf

http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCM30day.pdf