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Transitional Care Management CPT codes

Leslie Posted Thu 20th of December, 2012 19:36:08 PM

Our hospitalist has joined the ACO and I would be grateful if someone could provide some clarifications and links.

"According to the Centers for Medicare and Medicaid Services (CMS), an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it."

1)Should I be using Transitional care management services 99495 and 99496 for the initial encounter with the physician?
2) If these patients are seen again as f/u at the transitional care facility, can we bill 99214 and 99215(since they should be moderate and high MDM, established patient)?
3) OR can both the above codes be billed together?


SuperCoder Answered Thu 20th of December, 2012 21:46:25 PM


This is a useful link..

Please check Page 4-8 of the pdf, a helpful source

Prepare Now for New Transitional Care Codes

CPT® 2013 introduces two new codes for transitional care management (TCM) services:

99495 -- Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit, within 14 calendar days of discharge
99496 -- ... medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge.
The codes are meant to represent situations when a physician oversees an established patient whose medical/psychosocial issues require moderate to high complexity medical decision making (MDM) during the shift from a healthcare facility setting back to the patient’s community (home) setting. Another key to determining whether to report 99495 or 99496 hinges on timely follow-up -- how many days pass between the patient’s discharge and when the physician is able to see the patient.

Please suggest if these links were useful else we will dig more into and help you.

Thank You

Leslie Posted Thu 20th of December, 2012 22:35:16 PM

Please clarify the questions 1-3

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