Summary & Overview
HCPCS M1399: Patient Leaves Practice During Follow-Up
HCPCS Level II code M1399 documents patients who leave the practice during the follow-up period. This administrative code captures discontinuation of care or patient-initiated transfer away from the treating practice before scheduled follow-up care is completed. Nationwide, accurate use of M1399 affects quality measurement, continuity-of-care records, and administrative reporting for outpatient and clinic-based services.
Key payers discussed include Aetna; Blue Cross Blue Shield; Cigna Health; UnitedHealthcare; and Medicare. Readers will find a concise overview of the code's clinical and administrative context, payer coverage considerations, and the types of benchmarks and policy guidance typically relevant to codes that record patient departure during follow-up. The publication outlines where M1399 is used in practice workflows, typical sites of service, and common billing modifiers when available.
This summary provides a national perspective on the code's role in documenting care discontinuation, what organizations monitor when this code is reported, and the kinds of follow-up documentation and reporting issues that arise. Data not available in the input is clearly noted where applicable.
Billing Code Overview
HCPCS Level II code M1399 denotes patients who leave the practice during the follow-up period. This code is used to identify and report instances in which a patient discontinues care or transfers away from the treating practice before the planned follow-up interval is complete.
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Service type: Administrative or care-continuity event documenting patient departure during follow-up
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Typical site of service: Outpatient clinic or practice setting where follow-up would normally occur
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a patient who underwent a surgical or procedural intervention at an ambulatory surgery center or physician practice and requires scheduled postoperative follow-up care. The patient attends the initial postoperative visit but then discontinues care or relocates, leaving the original practice before the planned follow-up period is complete. For example, a 45-year-old patient undergoes a minor hand procedure at a community orthopedic clinic, attends the 2-week wound check, then moves out of state or transfers care and does not return for the 6-week follow-up. The clinical workflow includes: pre-procedure documentation of planned follow-up intervals, billing for postoperative visits or global period services as applicable, attempt(s) to contact the patient and document outreach, coordination of transfer-of-care documentation if requested, and closure of the episode when the patient is confirmed to have left the practice. Typical sites of service are ambulatory surgery centers, physician offices, and outpatient clinics where short-term postoperative follow-up is expected. Service type is administrative/clinical follow-up management associated with a patient who leaves the practice during the assigned follow-up period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required during the service was substantially greater than typically required. |