Nursing home discharge services

March 17th, 2010 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  
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Either a physician or an NPP may bill for discharge services from a skilled nursing facility or a nursing facility.  There are two discharge day management codes from a nursing facility.  99315 is for discharge day management 30 minutes or less, and 99316 is for discharge day management over 30 minutes.  Include in the time all of the services provided in the discharge:  meeting with the patient and family, examining the patient, discharge paperwork, and instructions to caregivers.  There are no specific history, exam or medical decision making requirements for this service.

Bill for the service on the date that the physician or NPP has a face-to-face service with the patient, even if that is not the day the patient goes home.  For example, if the physician sees the patient on Friday, June 1, and arranges for the patient to be discharged on Saturday, and the physician does not see the patient on Saturday, bill for the discharge on June 1, the day the patient was seen.

The physician may only bill for death pronouncement if he/she saw the patient on that day.  There is no billing for completing the paperwork, talking to the family and doing a discharge summary if the physician did not go to the nursing facility to see the patient.

Here is what the Medicare Claims Processing Manual says:

I  SNF/NF Discharge Day Management Service
Medicare Part B payment policy requires a face-to-face visit with the patient provided by
the physician or the qualified NPP to meet the SNF/NF discharge day management
service as defined by the CPT® code.  The E/M discharge day management visit shall be
reported for the date of the actual visit by the physician or qualified NPP even if the
patient is discharged from the facility on a different calendar date. The CPT® codes 99315
– 99316 shall be reported for this visit.  The Discharge Day Management Service may be
reported using CPT® code 99315 or 99316, depending on the code requirement, for a
patient who has expired, but only if the physician or qualified NPP personally performed
the death pronouncement.  (Section 30.6.13)

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