Forum - Questions & Answers

Jul 2nd, 2012 - PENTA

Specialist visits in the nursing home

I am trying to find out the best way to bill for a specialist in a nursing home. We are an ENT practice and only recently started seeing patients in a nursing home and what I've tried so far doesn't work. Are we able to use the outpatient codes and a 31 place of service? That hasn't worked. Do we use the nursing home visit codes?

Jul 2nd, 2012 - nmaguire   2,606 

re: Specialist visits in the nursing home

You code the Place of service the patient was seen and the appropriate CPT® nursing home visit codes. Example: POS 31 Skilled Nursing Facility--A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.
POS 32--Nursing Facility A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than mentally retarded individuals.
Medicare: In the Nursing home physicians who previously billed using an inpatient consult code will now use initial nursing home codes of 99304-99306. The admitting or attending physician will append the “AI” modifier to their charge.

Jul 2nd, 2012 -

re: Specialist visits in the nursing home

Thank you so much!



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