99495 and 99496 are current procedural terminology (CPT®) codes that describe Transitional Care Management Services (TCM). TCM services are performed during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation  hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/ nursing facility, to the patient's community setting (home, domiciliary, rest home, or assisted living). These services are for established patients with medical and/or psychosocial problems that require moderate or high complexity medical decision making. The individual reporting these services provides or oversees the management and/or coordination of services for all medical conditions, psychosocial needs, and activities of daily living support by providing first and continuous access.

Transitional Care Services must include the following required elements:

 ATC Oct ReveNews

Proper documentation of TCM services includes the timing of the initial post-discharge communication with the patient or the caregiver(s), the date of the face-to-face visit, and the complexity of medical decision making, in addition to the content of the face-to-face and non-face-to-face services provided during the calendar month.

1 2015 AMA Professional Edition CPT® current procedural terminology pages 48-49.
2 Ibid.

Reference:
CPT Assistant Archives (4th Quarter 1990 - present) – American Medical Association
2013 Transitional Care Management Services (April 2013, Volume 23, Issue 4, pages 3-4)

Author - Female

About the author

Stephanie Johnson, CHC, RHIT, CPC, CPEDS is Compliance Manager – Academic, Office-based and Multi-specialty Physicians of Studiomaca Business Performance Services.