Question

question 24

a patient is discharged from the hospital following a heart attack. the patient is initially contacted two business days after the discharge. the patients primary care physician manages the care of the patient during the transition to home care. the physician conducts a face-to-face visit on day 13 after discharge to home. during this visit, the physician reviews the patients hospital records, reconciles medications, and develops a care plan for the patients recovery. a moderate level of mdm is documented. what e/m code is reported?

99344
99305
99495
99214

Explanation:

Identify the service type

The scenario describes Transitional Care Management (TCM) services, which involve managing a patient's transition from an inpatient hospital setting back to their community setting (home).

Evaluate TCM criteria

TCM coding requires:

1. An initial communication with the patient or caregiver within 2 business days of discharge (met: contacted two business days after discharge).
2. A face-to-face visit within a specified timeframe.
3. Medical Decision Making (MDM) of a specific complexity during the service period.

Determine the specific CPT code

• CPT 99495 requires a face-to-face visit within 14 calendar days of discharge and moderate complexity MDM (met: face-to-face visit on day 13, moderate MDM).
• CPT 99496 requires a face-to-face visit within 7 calendar days of discharge and high complexity MDM.
• Therefore, the correct code is 99495.

Answer:

• 99344
• 99305
• 99495 (Correct answer)
• 99214