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Wiki TCM Clarification

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luvbuix

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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??
 
luvbuix said:
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??
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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.
 
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