TCM Codes

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We regularly bill Transitional Care Management codes (99495, 99496) in our practice.

We rarely find providers actually meeting the 99496 code due to the medical decision making of High Complexity requirement of the code. However, many providers still bill this code. We are trying to share some diagnosis examples of what would constitute high complexity with providers...problems they would actually see in the clinic.

Any suggestions on examples of diagnoses that would meet high complexity?

Thank you in advance!