Wiki Transition of Care

[houmaob1714]

If a patient is seen within 7 days of discharge and the documentation only meets moderate complexity, is it appropriate to bill 99495?

 

[twizzle]

Yes it is, assuming the interactive contact occurs within 2 business days of discharge and the provider personally documents the complexity of MDM as moderate (or high).

 

[OpenClaims]

If a patient is seen within 7 days of discharge and the documentation only meets moderate complexity, is it appropriate to bill 99495?

Yes, if the patient also meet the outreach goal of 48 hours in addition to being seen within the 7 days, then moderate complexity would result in a 99495 TOC code.

 

[lgardner]

If a patient is seen within 7 days of discharge and the documentation only meets moderate complexity, is it appropriate to bill 99495?

I agree with what those above have said, but another important detail is that the moderate complexity must apply to the post hospital conditions ONLY.
if other dx are assessed an additional E/M code may be billed.
if the hospital dx do not meet moderate complexity, only bill for an E/M.