Wiki Transitional Care

[munderwood]

On the transitional care codes 99495,99496, if the 30th day from discharge falls on a weekend would you use the next business day or the weekend date as your date of service?

Thanks,
Melody Underwood

 

[reac2005]

Would love a response

We have the same question in my office. I even posted the question to CMS, and have not received a response.

 

[munderwood]

Please let me know if you do hear of anything. I'm not aware of any denials
personally but one of the other ladies in the office said that Humana had
denied one because the weekend was put in as the date of service.

Thanks,
Melody

 

[reac2005]

response received from WPS

This is in response to the inquiry you submitted to Wisconsin Physicians Service (WPS) Medicare regarding the date of service billing requirement for transition care management (TCM) services (procedure codes 99495 and 99496).



In the document titled, ?Frequently Asked Questions about Billing Medicare for Transitional Care Management Services,? the Centers for Medicare & Medicaid Services (CMS) states the following regarding about the date of service:



?What date of service should be used on the claim?



?The 30-day period for the TCM service begins on the day of discharge and continues for the next 29 days. The reported date of service should be the 30th day.?



Since procedure codes 99495 and 99496 represent all of the TCM services provided over a 30-day period, it is appropriate to report the 30th day (i.e., 29 days after discharge) as the date of service even if the provider?s office is not open on that day. Providers should list the 30th day as the date of service whether it falls on a normal business day, a weekend, or a holiday.



You can find the CMS TCM FAQs on the CMS website at the following address:



http://www.cms.gov/Medicare/Medicar...ment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf
Hope this helps you as much as it did me.

 

[BenCrocker]

Well that makes sense.