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Nursing Facility Services

Erica Posted Wed 05th of August, 2015 16:22:15 PM

For codes 99307-99310 if a mid level nurse practitioner is doing these visits how often does the MD need to do a visit or are they just the supervising practitioner.

SuperCoder Answered Thu 06th of August, 2015 09:50:33 AM

Well, it is require to visit the place by physician, then only it can be billed as subsequent care. Hope it helps!

Erica Posted Thu 06th of August, 2015 10:05:05 AM

So are you saying a mid level nurse practitioner can not bill for these that only the physician can?
Also on the 99304-99306 can those ones only be used once every three years? or how are those worked. I wasn't able to find much in my Behavioral Health coding book on them.

SuperCoder Answered Fri 07th of August, 2015 08:33:31 AM

Well, no, I din't mean that, “In the inpatient hospital setting and nursing facility setting, any physicians and qualified NPPs who perform an initial evaluation may bill an initial hospital care visit code (CPT® code 99221 – 99223) or nursing facility care visit code (CPT® 99304 – 99306), where appropriate,” advises CMS in MLN Matters article MM6740. And as far as 99304-99306 is concern, you can bill these CPT codes may be used when admitted or readmitted to the nursing facility. Therefore, codes 99304-99306 may be used regardless whether a patient is admitted to a nursing facility for the first time or readmitted after a previous discharge or intercurrent hospitalization irrespective to time. Hope it helps!

Erica Posted Fri 07th of August, 2015 09:10:03 AM

Just to make sure I understand. So the 99304-99306 can be used when a patient is admitted or readmitted to a nursing facility correct? Like if they are discharged and two months later come back we can use one of those codes?

For the 99307-99310 you are saying if the physicians or NPP do the eval then they can bill for the subsequent care visits of 99307-99310?

SuperCoder Answered Mon 10th of August, 2015 02:41:02 AM

Well, code series 99304-99306 should be used for initial evaluation per day (first day) then code series 99307-99310 should be used on all subsequent days and use codes CPT series 99315-99316 for discharge. These series are for the same admit session. However, because CPT coding guidelines may differ from third-party payer guidelines, eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer. For reimbursement or third-party payer policy issues, please contact your local third-party payer. Hope it helps!

Erica Posted Wed 12th of August, 2015 12:11:02 PM

For Medicare guidelines can we bill 99307-99310 once a month when we are visiting the resident or does it have to be every 61 or 91 days?

SuperCoder Answered Thu 13th of August, 2015 02:55:33 AM

Well, yes, as per Medicare- it will be paid for federally mandated visits that monitor and evaluate residents at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. Submit CPT codes 99307-99310 (SNFC, per day) in the following conditions- (1) Federally mandated physician visits and other medically necessary visits, (2) Medically necessary Evaluation & Management (E/M)services, even if they are provided prior to the initial visit by the physician, (3) Medically complex care in a Skilled Nursing Facility upon discharge from an acute care visit, even if the visits are provided prior to the physician's initial visit. Hope it helps!

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