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Long term care Hospital

Dana Posted Thu 18th of July, 2019 09:40:59 AM
We have a vascular physician providing services to patients in a Long Term Care Hospital. He is overseeing the patients plan of care and does not always make face to face contact. What is the place of service code and what CPT codes should be used for these services?
SuperCoder Answered Fri 19th of July, 2019 07:25:21 AM

Long-term care hospitals (LTCHs) or Long-term care facilities (LTCFs) are certified as acute‑care hospitals, but LTCFs focus on patients who, on average, stay more than 25 days. Many of the patients in LTCHs are transferred there from an intensive or critical care unit. LTCFs specialize in treating patients who may have more than one serious condition, but who may improve with time and care, and return home. LTCFs generally give services like respiratory therapy, head trauma treatment, and pain management.

Long term care provided under Nursing Facility Services for New or Established patients. For Initial nursing facility care CPT code range 99304-99306 can be used and for Subsequent nursing facility care CPT code range 99307-99310 can be used. The following codes are used to report evaluation and management services to patients in nursing facilities (formerly called skilled nursing facilities [SNFs], intermediate care facilities [ICFs], or long-term care facilities [LTCFs]).

For CPT® code of Nursing Facility Service, the provider performs initial/subsequent/discharge nursing facility care for a patient. The provider spends face–to–face time with the patient and on the unit or floor. Also, there must be three of three key components (History, Exam and MDM) met to support the service level.

On the other hand, if provider only supervising the nursing facility patient, then use CPT 99379 {Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes}.

CPT 99379 can be billed for a physician or qualified non–physician provider supervising care for a patient in a nursing facility who requires medical attention from more than one medical specialty. The patient receives care indirectly from the provider while the patient is at the nursing facility. For example, a patient undergoing physical therapy for paraplegia and pressure ulcers may require this care. The physician discusses the patient's care with the dermatologist based on the stage of the pressure ulcers, arranges for nutrition services, and interacts with the nursing facility staff. In this service the provider supervises the development of the patient’s care plan. The provider can also make changes in care plans as per the progress or status of the patient. The provider is responsible for coordinating the care with other health professionals who are involved in the care of the patient, reviewing the status and test reports, and communicating the results and plan to the patient, family members, or direct care taker of the patient. Over the course of the calendar month, the physician spends 15–29 minutes in these activities. If physician spend more than 29 minutes, then use CPT 99380.

Place of service (POS) for the Skilled Nursing Facility is 31. This is the facility, in which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. Also, for Nursing Facility the POS is 32, facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. Check your documentation and select the appropriate POS and make sure check the payer policies regarding the same.


Hope this helps!

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