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Transitional Care Management definition (99496 & 99495)

Brad Posted Tue 25th of June, 2019 00:32:46 AM
To claim against code 99495 or 99496 have 3 requirements 1. Make initial contact with the patient within 2 days post discharge 2. Education & assessment of the patient 3. Face to face visit with the patient within 7 (99496) or 14 (99495) days Can requirement number 1 be claimed by using an automated technologies such as AI powered messaging or a chatbot? If so, how would this be reported back to medicare to be claimed?
SuperCoder Answered Tue 25th of June, 2019 09:00:27 AM



Regarding requirement number 1: - It is one of the three components of TCM and is known as “An Interactive Contact”. Within 2 business days following the beneficiary’s discharge, provider must make an interactive contact with the patients and/or their caregiver via telephone, email, or face-to-face. Provider or clinical staff can address patient status and needs beyond scheduling follow-up care. AI powered messaging or a chatbot are not allowed.


Please feel free to write if you have any question.



Brad Posted Wed 26th of June, 2019 02:41:10 AM
Thanks, are emails, video conferencing, telephone calls the only telehealth medium? Can a messaging/chat service (Not automated) be used from the provider to the patient, which is still asynchronous by nature.
SuperCoder Answered Wed 26th of June, 2019 06:54:34 AM



Messages and chat services may be used for telehealth care but these should be secure and HIPAA compliant.


Hope this helps.



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