Wiki TCM Clarification

[luvbuix]

My question for these 2 codes is: Do the level of decision making & the timing of the visit have to match or can it be one or the other? Example: MD sees the pt on the 8th day but decision making is high. Would they have to settle for the 99495 since the visit was outside the 7 days or can they bill 99496 based on the MDM??

 

[jkyles]

My question for these 2 codes is: Do the level of decision making & the timing of the visit have to match or can it be one or the other? Example: MD sees the pt on the 8th day but decision making is high. Would they have to settle for the 99495 since the visit was outside the 7 days or can they bill 99496 based on the MDM??

Hi there, according to the 2025 CPT manual you would report 99495. In other words, you have to hit the high MDM and the 7 day time limit requirement to report 99496.

 

[luvbuix]

I kind of suspected that- just wanted to be sure I was on the right track- Thanks!!