Don't have a TCI SuperCoder account yet? Become a Member >>

Family Practice Coding Alert

You Be The Coder:

Is SNF OV a No-No?

Question: A family physician treats a patient in the office who has Part A skilled nursing facility benefits. How should I code for the service?

New Jersey Subscriber

Answer: You should code the E/M service the same way you would for an outpatient. Assign the appropriate-level outpatient new or established office visit code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient -).

Even though services and procedures for SNF patients may fall under Medicare Part A coverage, physicians- services and the professional components of certain diagnostic procedures are exempt from consolidated billing. Therefore, you can report the office visit to your Medicare Part B carrier.

If the FP evaluates the patient at the facility, rather than at the office, you should instead code a nursing facility service. For a comprehensive assessment, use 99301-99303 (Evaluation and management of a new or established patient -). Assign a code from 99311-99313 (Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient -) for subsequent nursing facility care.

When reporting 99301-99313, you should enter place of service (POS) code 31 (Skilled nursing facility) in box 24b of the CMS-1500 form. Include the SNF's address and Medicare provider number in box 32.
Don't overlook: You may have to work out payment with the SNF if the service falls under Part A coverage. For instance, a patient receives physical therapy services, such as therapeutic exercises (97110) or massage therapy (97124), at your office. Medicare considers both of these services Part A coverage included in the SNF's consolidated billing. Therefore, you would have to bill the SNF for the physical therapy service.

Other Articles in this issue of

Family Practice Coding Alert

View All