Wiki tcm question

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Nhassan130

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Can someone please help me with this. My understanding when billing a TCM you have to see the patient for a face to face visit within 7-14 day. You would bill a 99496 or 99495 on the date the patient was seen and hold the claim for 30 days from discharge. I am being now told when the patient comes in for the face to face visit we would bill a regular office visit (99213) and then on the 30th day after discharge we would send out another claim with the 99496 and the patient doesnt have to be seen when we bill the second one ??? this doesnt seem correct to me
 
The TCM (99496 & 99495) covers 30 days of treatment for the SMARTC or DC dx. If that same pt reports back to your clinic to address totally unrelated dx, than you can bill a separate OV level for this visit. You must be able to show insurance carrier that this visit is not related to the TCM dx or your claim will be denied. We bill out our TCMs when they occur and monitor or any other visits.
 
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