Medical Billing Forum

Billing => Billing => Topic started by: PMBS on February 25, 2014, 12:57:32 PM

Title: CPT 99496 TRANSITIONAL CARE MANAGEMENT
Post by: PMBS on February 25, 2014, 12:57:32 PM
Does anyone bill for this procedure code?  Provider wants to start using this but I am a little confused as to how to bill.  Provider did see patient two days after discharge.  Do we bill for that visit or just the 30 day after?

Any help will be greatly appreciated.

Thank you
MR
Title: Re: CPT 99496 TRANSITIONAL CARE MANAGEMENT
Post by: shanbull on February 25, 2014, 03:29:15 PM
Medicare will pay for it, not all private insurers will. Definitely try it, but have the doctor be prepared to bill for a regular E&M visit instead if necessary. This explanation breaks down the coding and billing nicely: http://medicaleconomics.modernmedicine.com/medical-economics/news/user-defined-tags/99495/making-sense-new-transitional-care-codes (http://medicaleconomics.modernmedicine.com/medical-economics/news/user-defined-tags/99495/making-sense-new-transitional-care-codes)

This is another good PDF that discusses the 30 day time frame and what it means in relation to the patient actually coming in for an appointment: http://www.sccma-mcms.org/Portals/19/assets/docs/TCM-CPT.pdf (http://www.sccma-mcms.org/Portals/19/assets/docs/TCM-CPT.pdf)



Let us know if you need further clarification on anything once you read through those.
Title: Re: CPT 99496 TRANSITIONAL CARE MANAGEMENT
Post by: PMBS on February 27, 2014, 02:23:56 PM
Thank You.  So when the patient comes in to see the doctor 2 days after discharge can we bill for that visit?  Do we have to wait and only bill the 99496 on the 30th day?  This is what is confusing me on whether or not the provider could bill for an office visit when he sees the patient after discharge.

Thanks
MR