Subsequent Hospital Care, Inpatient

Transitional care management is essential in ensuring a smooth transition for patients, requiring precise coding to capture the comprehensive nature of transitional services. CPT code 99455 designates transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge and medical decision-making of at least high complexity during the service period. This code is applied when healthcare providers engage in transitional care management services, including communication with the patient or caregiver within 2 business days of discharge and medical decision-making of at least high complexity.

Details

CPT code:

99455

Category:

Category I

Section:

Evaluation and Management (E/M)

Specialty:

Special Evaluation and Management Services

Type:

Work Related or Medical Disability Evaluation Services

In the realm of transitional care management, 99455 plays a crucial role, representing services that include communication with patients or caregivers within 2 business days of discharge and medical decision-making of at least high complexity. Healthcare providers utilize this code to ensure accurate documentation of efforts in the comprehensive management of patients transitioning from one care setting to another.

Under what category does Subsequent Hospital Care, Inpatient fall?

Category I

What is the billing unit for Subsequent Hospital Care, Inpatient?

Per Encounter

Modifiers

Clinical use

Care management services for behavioral health conditions, at least 50 minutes of clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month.

Documentation

Prolonged service in the inpatient or observation setting, requiring direct patient contact beyond the usual service; first hour. Document the prolonged service, including the start and end times, and describe the specific activities or discussions that required the additional time.