AMA CPT® Assistant - 2014 Issue 3 (March)
Evaluation and Management: Transitional Care Management Services [(Q&A)] (March 2014)
March 2014 page 13 Evaluation and Management: Transitional Care Management Services Question: If multiple physicians are involved with the patient's care and the patient is being transferred to an extended care facility, can multiple physicians report codes 99495 and 99496? Answer: No. As stated in the Transitional Care Management (TCM) guidelines in the CPT® 2014 code set, "Only one individual may report these services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within the 30 days. The same individual may report...
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Article Overview
This article explains a transitional care management question and answer from a CPT Assistant issue focused on evaluation and management services. It is relevant to coders, billers, and compliance staff who handle post-discharge care transitions and need to understand the general scope of the CPT guidance discussed in the article. The article covers who may report these services, the timing and encounter components involved, and related reporting considerations in care transition settings.
Why This Topic Matters
Transitional care management is commonly used in post-discharge scenarios, so understanding the article helps support accurate E/M reporting and avoid duplicate or inappropriate reporting during care transitions.
Article Sections
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Question
Introduces a coding and reporting question about transitional care management in a care transition scenario.
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Answer
Summarizes the guidance discussed in the article, including the general reporting framework and timing-related elements associated with transitional care management services.
What You Will Learn
- The general purpose and scope of transitional care management guidance
- How the article frames reporting in a care transition setting
- Which types of service components and timing requirements are discussed at a high level
- How the article relates transitional care management to evaluation and management reporting
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Hospital revenue cycle teams
Codes Discussed
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