Subsequent nursing facility visits

March 17th, 2010 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  

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.



Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM Codes
October 5th, 2023 - Aimee Wilcox
Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance
September 19th, 2023 - Aimee Wilcox
Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative Visits
September 12th, 2023 - Aimee Wilcox
Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period? 
Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
August 22nd, 2023 - Aimee Wilcox
Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association