Internal Medicine Coding Alert

CPT 2008: Find Out How to Code 99305-99318 Based on Time


- Published on Fri, Nov 02, 2007


You’ll need solid counseling/care coordination notes for new nursing facility codes


You’ll finally be able to use time as the key element when coding counseling-dominated nursing facility encounters. CPT previously did not include time guidelines for coders to observe. The codes were listed based on the severity of the problem(s) or the patient’s status.


In 2008: Each nursing facility care entry includes a typical timeframe for that level of visit.



Check Last Sentence of Descriptor for Time Guideline



The new definition of 99304 reads "Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision-making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver."


The last sentence of the definition, which provides a timeframe for 99304, was not part of the descriptor last year. "This change is a help to coders," says Quinten Buechner, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis.


Benefit: The rewritten descriptors will make the prolonged services codes easier to report. However, "the trick is getting the physicians to document the time spent in counseling and coordination of care," Buechner says.


The other revised codes in the nursing facility section of CPT 2008 are:


• 99305 -- … a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver


• 99306 -- … a comprehensive history; a compre-hensive examination; and medical decision-making of high complexity. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver


• 99307 -- Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; straightforward medical decision-making. Counseling and/or coordi- nation of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 10 minutes with the patient and/or family or caregiver


• 99308 -- … an [...]

Internal Medicine Coding Alert
Issue - Nov, 2007
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