Physicians now have available to them transitional care management codes which are intended to report follow-up care given to patients upon discharge from a facility setting to their community setting.
Oftentimes transitional care is much more involved than an ordinary office visit in terms of the coordination of care with family or caregivers and the complexity of medical decision making as well. Patients seen within 7 days of discharge from a facility setting are less likely to return to the facility setting with complications and these codes are a win win for the patient, the facility, and the provider.
The first code is 99495, practice RVU is 5.20307 or allowed Medicare amount of 177.02 for the Metro Boston area, requires the following:
-Communication with the patient/or caregiver within 2 business days of discharge, this can be direct, telephone, or electronic.
-Medical decision making of at least moderate complexity.
-And a face to face visit within 14 calendar days of discharge.
The second code is 99496, practice RVU is 7.32965, or allowed Medicare amount is 249.38 for the Metro Boston area, requires the following:
-Communication with the patient or caregiver within 2 business day of discharge, this can be direct, telephone, or electronic.
-Medical decision making of high complexity during the service period
-And a face to face visit within 7 calendar days of discharge.
Using these codes can impact your revenue in a positive way, especially if you have a high percentage of patients that are in and out of the facility setting. As always don’t forget to document all of your communications, both face to face as well as telephone and electronic. If an unusual amount of time is spent be certain to document the time portion of your visit as well.
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