99496- billable if patient passes during 30 day period

Received a call from my biller yesterday indicating that since Mr X passed from his end stage metastatic lung cancer during the 30 day post hospital period and after my TCM visit, I am unable to bill 99496 and must change to a standard established visit code.. My research on this has turned up nothing. I am uncertain as to why the code requires a change. Any input/education would be appreciated. On top of this, the hospice service is still submitting for their services post mortem.

re: 99496- billable if patient passes during 30 day period

Your Biller is correct. The key to billing this code according to CPT guidelines is the TCM commences upon the date of discharge and continues for the next 29 days. Therefore, If the patient expired prior to the 29th day and the practitioner did not complete the 30 days of care, another code should be billed, such as the appropriate E&M code.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf

also here are some FAQ’s that may help.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf