Question Transitional Care Management (99495 and 99496) with a Medicare Wellness

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79
Location
Harrisburg, PA
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0
Hi everyone,

Can you bill Transitional Care Management (99495 and 99496) with a Medicare Wellness on the same day? I have checked on my MACs website and NCCI edits, but found nothing. I have a provider asking so I need documentation if this is correct or not.

Any help would be greatly appreciated.

Thank you.
 

Tewisdom

New
Messages
7
Location
Indianapolis, IN
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0
Hi,
I did not find anywhere in the MLN documentation that an AWV could be billed on the same day as TCM Services. I did attach the MLN notice from Medicare for your review.
 

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  • Transitional_Care_Management_Services_MLN908628.pdf
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TThivierge

Expert
Messages
382
Location
Atlanta, GA
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0
Hi Ivy Girl :)
In medical office use to work in we did bill both CPT 99495 or CPT 99496 and annual wellness same date. Adding modifier 25 on annual wellness CPT. However documentation had to be such as provider must mention hospital or nursing home or ETC where discharged from, date discharged (hopefully before 7 day or 14 days past) on top of medical record. Then disease or injury pt. inpatient for and how doing, compare meds,. then pt could be assessed a HPI for annual wellness exam vitals, meds and ongoing issues checked and documented in record and listed all diagnosis. There are services cannot bill same time as TCM. There are services that CANNOT be billed during the 30-day TCM period CPT 99495 or 99496 by the same provider because they are considered duplicative of the work performed for TCM. Such non-billable services with TCM include: Home healthcare oversight (G0181) Hospice care plan oversight (G0182) Care plan oversight (99339, 99340, 99374-99380) Chronic care coordination services (99439, 99487, 99489-99491)Prolonged services without direct patient contact (99358, 99359) Medical team conferences (99366-99368) Education and training (98960-98962, 99071, 99078) Telephone services (98966-98968, 99441-99443) End stage renal disease services (90951-90970) Online medical evaluation services (98970-98972) Preparation of special reports (99080) Pharmacy Medication therapy management services (99605-99607).

But if doctor phone or does video telehealth can add modifier 95 on CPT 99495 and CPT 99496 as long as state all data above AND it is phone or video telehealth in notes listing minutes and verify correct pt. speaking too and patient' s permission. Also only 1 doctor can do this TCM after pt discharged...first come first served get the reimbursement
Did I help you? I hope so. Have a great day!
Lady T 😷🏥
 
Messages
79
Location
Harrisburg, PA
Best answers
0
Hi Ivy Girl :)
In medical office use to work in we did bill both CPT 99495 or CPT 99496 and annual wellness same date. Adding modifier 25 on annual wellness CPT. However documentation had to be such as provider must mention hospital or nursing home or ETC where discharged from, date discharged (hopefully before 7 day or 14 days past) on top of medical record. Then disease or injury pt. inpatient for and how doing, compare meds,. then pt could be assessed a HPI for annual wellness exam vitals, meds and ongoing issues checked and documented in record and listed all diagnosis. There are services cannot bill same time as TCM. There are services that CANNOT be billed during the 30-day TCM period CPT 99495 or 99496 by the same provider because they are considered duplicative of the work performed for TCM. Such non-billable services with TCM include: Home healthcare oversight (G0181) Hospice care plan oversight (G0182) Care plan oversight (99339, 99340, 99374-99380) Chronic care coordination services (99439, 99487, 99489-99491)Prolonged services without direct patient contact (99358, 99359) Medical team conferences (99366-99368) Education and training (98960-98962, 99071, 99078) Telephone services (98966-98968, 99441-99443) End stage renal disease services (90951-90970) Online medical evaluation services (98970-98972) Preparation of special reports (99080) Pharmacy Medication therapy management services (99605-99607).

But if doctor phone or does video telehealth can add modifier 95 on CPT 99495 and CPT 99496 as long as state all data above AND it is phone or video telehealth in notes listing minutes and verify correct pt. speaking too and patient' s permission. Also only 1 doctor can do this TCM after pt discharged...first come first served get the reimbursement
Did I help you? I hope so. Have a great day!
Lady T 😷🏥
Due to nothing saying you can or can't bill these two together, do you interpret that as it being allowed?
 
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