Transitional Care Management, High Complexity

CPT code 99496 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:

99496

Category:

Category I

Section:

Evaluation and Management (E/M)

Specialty:

Transitional Care Management Services

Type:

Transitional Care Management Services

Within the landscape of transitional care management, 99496 holds significance, 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 Transitional Care Management, High Complexity fall?

Category I

What is the billing unit for Transitional Care Management, High Complexity?

Per Encounter

Modifiers

Clinical use

Prolonged physician service in the inpatient or observation setting, requiring direct patient contact beyond the usual service.

Documentation

Prolonged physician service in the inpatient setting, requiring at least 15 minutes beyond the usual service. Clearly document each additional 15-minute increment of prolonged inpatient service, including the start and end times, and describe the specific activities or discussions justifying the additional time. (Critical care, each additional 30 minutes)