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Eli's Rehab Report

Clear Up Coding Confusion for Nursing Facility Assessments for Rehab Patients

- Published on Thu, Feb 01, 2001
Comprehensive nursing facility assessments (99301-99303) can confound even the most expert coder because they dont always follow the same rules that govern other evaluation and management (E/M) codes. Because many physiatrists perform nursing facility assessments for their patients, such as those suffering from strokes (436), multiple sclerosis (340), paraplegia (ICD-9 344.1 ) and other conditions, clearing up confusion about these codes is important for proper reimbursement.

Facilities that provide convalescent, rehabilitative or long-term care must perform assessments of the patients condition when he or she is admitted to the facility and annually thereafter. Assessments also must be performed whenever the patients status undergoes a major permanent change.

Assessments Affect Total Reimbursement Outlook

There are a number of issues that make these codes unusual, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a national healthcare consulting firm based in Lansdale, Pa., that specializes in financial and healthcare management with a focus on physician compliance, coding, billing and reimbursement.

Coders must be alert to these key differences to assign the assessment codes correctly. This is especially important given the high relative value units (RVUs) assigned to these codes. Correct coding can make a significant difference in the level of reimbursement received.

Even more important than the reimbursement for the assessments RVUs, these codes affect a patients total care allowance for the year, says Laureen Jandroep, OTR, CPC, CCS-P, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J. Jandroep has participated in nursing facility assessments as a practicing occupational therapist and played a role in determining patients care plans following assessments. With the prospective payment system (PPS) entering the long-term care arena, the nursing facility assessment really affects reimbursement. The assessment determines what needs the patient has and how sick he or she actually is. During the assessment, the physician determines whether the patient requires additional assistance or care, and those factors go into the calculation of the patients minimum data set (MDS) rate, which in turn determines the prospective reimbursement.

The Basics of Nursing Facility Assessments

Nursing facility assessment codes are complex evaluations because they cover the entire scope of the patients care, not just the factors that make up the typical sick visit E/M codes, says Jandroep. The assessment looks at the patients nutritional and psychosocial status, his or her functional status and impairments, and the rest of the patients total medical profile. Use these four key factors in determining how to code nursing facility assessments:

1. Assign 99301, 99302 and 99303 for services provided to both new and established patients. There is no distinction between new and established patients with these codes, Falbo [...]

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