Forum - Questions & Answers

Mar 9th, 2015 - kjstremont1 7 

99496 Transitional Care Mgt

In order to bill for Transitional Care Mgt level 99496, the patient must be seen within 7 days of hospital discharge. Does the discharge date count as day 1? or is it within 7 days AFTER hospital discharge. Our doc wants to bill for one & they were seen exactly 7 days after they were discharged.
Thanks for your help!

Mar 11th, 2015 -

re: 99496 Transitional Care Mgt

the patient can be seen in the office within 14 days of hosp d/c, not 7. CPT® 99495 is 14 calender days- CPT® 99495 is within 7. Your DOS on your claim is going to be the day of hosp D/C plus 29 calender days (include the weekends). You will hold your claim until this date then submit. There are VERY particular doc req for this code. I strongly suggest following a template available online. Also MLN Matters website has a great handout explaining all of the requirements.

Mar 11th, 2015 - kjstremont1 7 

re: 99496 Transitional Care Mgt

My only question is regarding billing the higher level 99496 (not 99495). The requirements state the patient needs to be seen with 7 days of hospital discharge. I'm just asking if the date of discharge counts as day one? If so, this patient was seen on day 8 so we would not bill the higher level.



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