Nursing Home Consultations

I am hoping Nancy Maguire will be able to help me with a nursing home consultation situation. I know the guidelines for inpt consultation state 1 consult per admit. What happens with nursing homes when a patient may be in for 5 years? I have been asked to bill for a dermatologist who sees patients in nursing home. Many patients are seen 1-2 years apart and the diagnosis is completely for a second consultation 1-2 years after the first. However the patient is not discharged and then admitted again so I am unsure if I can bill another consultation or do I have to stay in the subsequent visits. What about the 3 year rule for a patient now being considered new? If the dermatologist sees a patint in 1/2006 and is caloled in again 6/2009, 3 yers have passed. If 1 per admit is the rule, can this patient be considered new and a consultation be performed?
At the AAPC RAC workshop one of the attendees who works for a billing company said the 1 per admit guideline was only for internal medicine, not for specialists. I have not heard this, is there any truth to this statement?

nursing Home

Medicare covers the cost of a nursing home stay only under certain circumstances. The criteria are as follows:

1. The individual requires skilled care (i.e., nursing care other than general custodial, intermediate or personal care).

2. The care is provided only after a three (or more) day hospital stay for treatment of the same illness or condition that was treated in the hospital.

3. The nursing home is a Medicare-approved skilled nursing facility with a registered nurse on duty 24-hours a day.

4. The patient is assigned to a bed that is Medicare-certified for reimbursement.

5. Only a nursing home can provide the skilled care required.

Even if these criteria are met, Medicare only covers the costs of care for up to 20 days. An additional 80 days may be provided on a co-payment basis.
About half of all nursing home residents pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.

Again, a consultation must be medically necessary and whether a new or established patient, is not relevant for a consultation. Each note must stand on its own and medical necessity.

If the dermatologist is seeing the patient for the condition previously consulted on, it is a subsequent visit code. In the nursing facility setting, following the initial consultation service, the Subsequent Nursing Facility (NF) Care codes (new CPT codes 99307-99310) shall be reported for additional follow-up visits. The 3 year rule applies to NF for subsequent encounters for new/est patients.

If 1 per admit is the rule, can this patient be considered new and a consultation be performed? "new" has no bearing on billing a consult.

Additional initial inpatient consultations (99251-99255) may not be reported by the same consultant if the patient develops a new problem during the same hospital/nursing facility stay. These encounters should be reported subsequent visits.