jimbo1231
Expert
I do audit educations. I've noticed that the auditors almost never accept 99496, TCM requiring high MDM. The providers typically comply with the other requirements including the 7 day face to face. Applying the MDM tool it seems nearly impossible to get to High MDM for TCM. Regardless of how sick the patient was and comorbidities, at the point of discharge they are (hopefully) stabilized. So the first column requiring severe exacerbation or threat to life almost never comes into play at the point of the within 7 day visit. I raised that question at Healthcon and the physician expert agreed that 99496 is very difficult to support. I took a look at the vignettes and the examples they gave were patient's who were very sick while in the hopsital. But the auditors can only go on the MDM documented for the within 7 day visit. unless I'm missing something?