# Cpt 99495/99496



## mgatsos@yahoo.com

Has anybody tryed coding/billing for these transitional care management services?  If so what was used for the DX....any reimbursements yet?


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## lmc4268@yahoo.com

I was pleased to see this question asked and disappointed that no one responded.  My practice is looking for some guidance as well.  Have you gotten any information elsewhere on these codes?


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## orthobiller2000

*transitional care management services*

We're an Orthopedic office and wondered if anyone else has reviewed the documentation in cpt-from what I have read this cannot be billed during global post op period.  Any other thoughts.  Thanks


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## Kristi Petersburg

? on 99495/99496 what DX should we use as the primary
Does it matter


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## cheermom68

There has been nothing published that I have seen, but I would use the reason for hospitalization and perhaps the V code for follow up.


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## Kclose1975@yahoo.com

Has anyone received payment from Medicare for these codes?  From what our group is understanding you can't submit these codes under thirty days after discharge???  Medicare can't give me a clear answer on these, however the Medicare advantage payers are paying with no problem.


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## cypress4334

From what I have read, you have to bill the codes on the 30th day after discharge. The hosp rep just came over today to tell me that those codes must  be followed by a RN, LVN, NP or the doctor . MA or office staff does not count, for the communication within 2 days to patient or caregiver. I told her I would have to look into the guidelines. Just a fyi I currently am not billing these codes because I have heard so many different stories and read so many things that I am not really sure how to bill them.


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## chavera

*Billing*

Hello,

I work for a family practice and we have started billing the codes. From what we gathered upon researching the codes you can't bill until 30 days post discharge date, since the treatment plan the doctor is creating for the patient should last for 30 days to make sure they are not re-admitted. We did receive payment from Medicare and it was about $164! The dx we billed are the ones that are related to why the patient was in the hospital and required further treatment after they were discharged. Now if the patient comes back in within the 30 days of the treatment plan you cannot bill a separate office visit unless if what they are coming in for are unrelated. Hope this helps


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## scredhead@live.com

*TCM codes*

I work for a primary care provider and we do bill and get reimbursed for these codes. Patient is contacted following discharge and appointment for follow up is set. While we put one of the TCM codes on the chart, we do not bill until 30 days have elapsed from date of discharge. We also hold any other e&m's for that patient during the 30 day period, in case the patient returns to the hospital and we have to change the original tcm to an ov. After 30 days we bill the charge with a collection note for our reference, stating where notes are for that charge. We use the diagnosis for the hospital visit as well as any other pertinent current ones.


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## bsesender

*unrelated office visit*



scredhead@live.com said:


> I work for a primary care provider and we do bill and get reimbursed for these codes. Patient is contacted following discharge and appointment for follow up is set. While we put one of the TCM codes on the chart, we do not bill until 30 days have elapsed from date of discharge. We also hold any other e&m's for that patient during the 30 day period, in case the patient returns to the hospital and we have to change the original tcm to an ov. After 30 days we bill the charge with a collection note for our reference, stating where notes are for that charge. We use the diagnosis for the hospital visit as well as any other pertinent current ones.



i am going to bill my first... but this patient in addition to her follow up visit that is bundled also came in for another visit that was unrelated to medical condition.  have you encountered this and if so, how did you bill-- how do you notate you've already had one bundled visit and this is an additional?


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## Pam Brooks

The diagnosis code to use is the one that supports the planning outlined on the discharge summary---TCM is to provide care management post-discharge to prevent readmission.

We are getting paid.

There are a couple of huge threads on this board with details about TCM. Essentially, they're not billable by surgeons who are bumping up against global days.  They're mostly for primary care physicians to utilize, as they manage their patients' chronic conditions.  Do a search on this discussion board, and the threads should show up.


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## mjs1974

It has to be 30 days exact. If patient discharge 3/4/14. Dos on claim should be 4/6/14. Dx code does not matter


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