tci Part B Insider - 2013 Issue 35

Reader Question

Question: I think the transitional care management codes only apply to established patients, but my physician keeps reporting them for new patients, and he did get paid for one of these claims. Is this accurate or should we pay that money back for the TCM billed for a new patient? Answer: Your physician is right, but it’s no surprised that you’re confused about this. CPT® 2013—which debuted the TCM codes—was unclear. However, CPT® 2014 promises to work some of the kinks out of codes 99495 (Transitional care management services with the following required elements:...

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