Physicians Organization Offers Help to Understand New Transitional Management Codes

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The American Association of Family Physicians (AAFP) is offering guidance to members confused about the new CPT codes for transitional care management (TCM), 99495 and 99496.

The new codes for moderate- and high-complexity, respectively, became effective Jan. 1.  AAFP has created two free tools, which can be found here, to help members assimilate the new codes into their billing processes:

A frequently-asked-questions (FAQ) that provides concise answers to 21 basic questions about the new codes, among them:
  • when to use TCM code 99495 versus 99496,
  • coverage of services delivered in a manner other than face-to-face,
  • expected payment for each code,
  • specific time elements associated with the new codes, and
  • circumstances that would limit physician use of either TCM code.
 And a transitional care management 30-day worksheet to help physicians log important information in the patient’s transitional care summary, including must-have dates and discussion notes. The worksheet also helps physicians assess and tabulate the level of their medical decision-making — be it moderate or high — during a patient’s care transition.
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Posted in Denials Management, Medical Receivables, Patient Financial Services .

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