Can a physician practice open an office in a nursing home?

March 17th, 2010 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  
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Physician visits in a nursing home are billed with nursing facility codes and place of service. But, what if a physician opens an office there?  Are those services billed as office visits?

A physician practice may established an office in a nursing home, if it pays rent at market value, and is used by the physician for the rental period.  The physician must be responsible for expenses that would be typical in the office:  supplies and staffing.  The rental agreement will probably include the cost of utilties, and may include equipment, depending on the arrangement.  It is not a physician office if it is a room that the nursing facility makes available from time to time.

If the physician establishes an office in the nursing home, and patients come to see the physician in that location, then the physician may bill office visits, using place of service office. When the physician leaves the office and visits patients in their rooms in the nursing facility, bill with nursing facility codes and place of service.

Be careful about billing for Non-Physician Practitioners (NPP's).  There is no incident to billing in the nursing facility, and unless the physician is on site, in the office at the time the NPP was seeing patients in the office in the nursing facility, no incident to billing there.  That means, bill for the NPP under their own provider numbers.  See the Codapedia articles on incident to billing and shared services.

If you have experience with this situation, please add an article on the topic, with citations.

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