Subsequent nursing facility visits

March 17th, 2010 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  
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Subsequent nursing facility visits (99307--99310) are services billed for either mandated or medically necessary visits in a skilled nursing facility or nursing facility.  (Place of service 31 for a skilled nursing facility or 32 for a nursing facility). These codes may also be used in place of service 54 (Intermediate  care facilty/mentally retarded) and 56 (Psychiatric Residential Treatment Center).  These visits are Evaluation and Management services which require 2 out of 3 of the key components.  A clinician may use time to select the code, if the requirements for doing that are met.  There is a chart in the resource page that shows the level of history, exam and MDM required for each level of service and the typical times.  Review the article in Codapedia on using time to select a code.

All of these visits are per diem codes.  Only one visit per calendar day is payable, even if the patient was seen more than once.  If the patient was seen more than once, you can add together the documentation for the services to select the level of visit,

These visits may not be billed as shared services or incident to services.  That is, they may be performed by either a physician or a qualified Non-Physician Practitioner (NPP) but must be billed under the provider number of the professional who provided the service.  If the NPP performed the visit, bill under the NPPs provider number.

When the patient is in the skilled nursing facility, the physician and NPP may alternate visits.  In a nursing facility, a physician may delegate the subsequent visits to the NPP.

A subsequent nursing facility code may be billed prior to the comprehensive nursing assessment, that is the admission.  A patient who is admitted to the nursing facility who needs assessment and treatment for complex problems may be seen first by the NPP using the subsequent nursing facility codes.  Typically, the NPP is on site and available to do this assessment.  The physician would then bill for the comprehensive nursing assessment--what we tend to call the admission--after the NPP had billed a subsequent hospital visit.

There is a section in the manual about gang visits.  Medicare uses this to describe a physician visiting many patients at a single visit to the facility.  Medicare wants to be sure that each visit was medically necessary.  When called to see a patient by a nurse, or asked by a family member to see a patient, document that and the reason.

Be careful about billing a subsequent nursing facility visit with a procedure.  For example, a Podiatrist who provides covered nail care to a diabetic patient should not bill a nursing facility visit with the procedure every time.  It would not be medically necessary to bill a visit with each procedure.  Typically, the procedure is a planned, repeat procedure.  Bill only the procedure after the initial assessment is made.  Billing the lowest level code with the procedure every time is like calling Medicare and asking them to audit your records.



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