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Wiki Transitional Care Management

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TMB1965

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When a physician does a hospital follow up do you bill the transitional care 99496 30 days after the visit? Also if the patient happens to come in during the 30 days for another office visit then do you bill the TC visit just has an E/M visit? Example below:
Pt. comes in on 9/1/13 for his hosp f/up, then on 9/15/13 he comes in again for something else, so on 10/1/13 do I bill the TC 99496 for his 9/1/13 visit or do I bill a 99215? I'm a little confused, because I'm being told yes and no. Any help would be greatly appreciated! :) Thank you!
 
You would bill the TCM for the first service, thirty days (with the date of hospital discharge being day one) after that, then bill the next visit as an E/M. I had several denials on these codes due to them changing the DOS requirements on the claim. Apparently, even though you actually perform the service within 7 to 14 days of the hospital discharge, they want the DOS on the claim to reflect 30 days from the date of discharge instead of the actual date the service was performed. At least this has been my experience so far.

Hope this helps!

Teresa M. Pearce, CPC, CIMC
 
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