Forum - Questions & Answers

Jun 5th, 2015 - jonesy

Nursing Home Billing

My doctor spent 30 minutes face to face with a nursing home patient for presenting problem (billing a 99309) and an additional 30 minutes on the phone with the patient's family coordinating the care for discharge planning in appx. 2 weeks for a total of 65 minutes. What CPT® can I use for the coordination of care or should I bill 99310 based solely on time?

Jun 6th, 2015 - MUMD 1 

re: Nursing Home Billing

30 min with the patient regarding the presenting problem and 30 min coordinating care =60 min total visit time. only 50% (not >50%) was spent on care coordination so this would be a 99309. However, if the total visit time was documented as 65 min with the above information, the visit would be rejected by an auditor because the time does not add up. Care coordination codes for the nursing homerefer to time spent off site addressing care coordination over a calendar month's time, they have their own restrictions but cannot be coded until the total time period is up. Same with the medicare medical home care coordination codes, although the requirement for them is much more onerous

BTW. the time based codes for NH are not necessarily for face to face activity such as for office based codes. Rather, they refer to total time spent on ward and the % time counseling patient or anyone else involved in the care as well as coordinating the patient's care. Make sure your provider is not documenting out too much time in a given day, auditors will pull entire days worth of notes, add up the times that our documented and see if the total exceeds a reasonable time. For that reason it is recommended to document the actual times ( 1200 to 1300) to prevent overcoding based on time

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