Wiki Transitional Care Management

[stephmescher]

Hello,
A septic patient is released from the hospital, we make the phone call at day 2- patient presents to the office within 7 days and the sepsis is completely resolved and no other concerns for the visit- are we able to charge the 99496.
The physician reviews the hospital notes but there is no additional lab work or prescriptions needed. I feel as though this would be just a regular office visit but having a debate of the severity of the condition in the hospital. Since this has resolved and is not an active problem that is being addressed in the current visit, would this qualify for transitional care management.
Looking for some guidance.
Thanks
Steph

 

[jkyles]

Hi there, this sounds like an office visit. Not every patient who was very ill while in the hospital will need TCM.

I recommend comparing the documentation for the visit to the CPT guidelines for the code, including whether the medical decision making for the visit was high. Remember to check the carrier's guidelines as well.