A congestive heart failure patient is discharged from the hospital and has a follow up appointment with his primary care physician five days after discharge. The primary care physician's office calls him within 36 hours after discharge to follow up by phone to see how he is doing. Because he has had weight gain since leaving the hospital, the primary care office requests to see him that same day to see if this gain is from fluid retention and related to his congestive heart failure. He is seen in their office and the medical decision making is considered moderate complexity. What is the correct evaluation and management code for this patient?

Question

Quizplus · Accepted Answer

99495 is the correct code for transitional care management services of a patient requiring at least moderate-complexity medical decision making, who is contacted within two days of discharge date by phone, direct contact or email and who has a face-to-face appointment scheduled within 14 days of discharge.
Code 99496 is incorrect because this code requires face to face within seven days and also requires high-complexity medical decision making. Codes 99497 and 99498 are both incorrect codes because these refer to advance care planning.

A Congestive Heart Failure Patient Is Discharged from the Hospital