Definition:
CPT® 99496 describes a high-complexity transitional care management (TCM) service for patients within 7 days of discharge from a hospital, skilled nursing facility, or other inpatient setting. This service involves interactive communication, comprehensive review, and coordination of care to ensure a smooth transition from inpatient to outpatient management.
When to Use:
- For patients discharged from a hospital, skilled nursing facility, or similar setting.
- When the patient requires moderate-to-high complexity medical decision-making.
- Includes reviewing discharge instructions, medication reconciliation, scheduling follow-ups, and coordinating with caregivers or other providers.
Documentation Requirements:
To support billing for CPT® 99496, clinicians should document:
- Date of discharge and the date of TCM service.
- Complexity of medical decision-making and patient care needs.
- Patient or caregiver contact (phone, electronic, or face-to-face).
- Follow-up plans, referrals, or care coordination completed.
Key Notes:
- CPT® 99496 is billed for high-complexity TCM; lower-complexity cases use 99495.
- Time-based billing is critical; services must occur within 7 days post-discharge.
- Proper documentation ensures compliance and maximizes reimbursement.
How OptiMantra Supports 99496:
OptiMantra’s EMR and practice management platform enables providers to track post-discharge patient interactions, document complex care coordination, and ensure all follow-up tasks are completed. Integrated tools help generate clean, compliant claims while supporting smooth transitional care for better patient outcomes.
Try OptiMantra for free here!
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