# Cpt codes 99495 & 99496



## OPENSHAW

Has anyone used these codes, 99495 and 99496?  Does anyone know the criteria that needs to be met in using these codes?  Does the caregiver have to be the pcp or could it be the specialist?  In order to bill these codes what conditions have to be satisfied to bill them?  I appreciate any help regarding this.  Thank you!


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## cardiology

This is the same question I have too.
When you get some information please let me know too.
I posted same question last night but still waiting.

E-mail: jnninso@yahoo.com
Thank you,
Cardiology


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## samsaldukas@aol.com

Maybe this will help??? It isn't for cardiology, but the rules are the same. 

TCM Article
TCM Cheat Sheet

Sam


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## Twixle2002

My issue is that most insurances do not recognize these codes yet and are denying them.. Medicare is one of the culprits doing this.  Is anyone else having problems with these codes?


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## decus1956

*99495*

Are you waiting 30 days after dischg from hospital....My info is that your to bill code on 31st day after dischg.  I am holding my claims and billing them on the 31st day.  I have had one claim paid, but it was BCBS and I sent it by mistake before the 31st day.  I do know Mcare is denying them if sent before 30 days.  I also know that the doctor or specialist who gets there claim in first is the one who will get paid.  If it denies after that,  Then you will need to go back and resubmit claim with 99213, etc in order to be paid


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## jadedaryl

*billing TCM codes*

the TCM codes have to be billed on the 30th day after discharge even if this date lands on a weekend that is the date to bill. I have billed over 70 of these TCM and have gotten paid on 62 of them - BCBS will pay for these.
Only 1 TCM can be billed every 30 days-any specialty can bill this- so first one in with the claim will get the payment anyone after this will have to charge a regular office visit.

Criteria for the TCM isthis must be in doctors  dictation)

Medical Decision Making must be at least Moderate complexity
patient must be contacted within 2 business days of discharge(via phone,electronics or caregiver
patient must be seen face to face within 7 calendar days of discharge to bill a 99496(high complexity)
patient must be seen face to face within 14 calendar days of discharge to bill a 99495(moderate complexity)
if patient is readmitted before the 30 days the first face to face will be billed as regular
office visit and then the TCM will be billed 30 days after the second discharge

I have created a spreadsheet that I keep all this information on and view regularly so can keep track of when I need to bill the TCM. This has been a trial and error thing for me. I have even had Nurse Practitioners bill this and have gotten them paid also.


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