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office visit while patient in long term facility

Heidi Posted Thu 02nd of March, 2017 09:15:03 AM
if a patient comes to office while in long term facility what CPT code or modifer should we use?
SuperCoder Answered Fri 03rd of March, 2017 13:50:54 PM

Hi Sherry, 

The appropriate CPT code to bill for office visit after long term in facility will be 99495 or 99496 depending on the available documentation. You may also follow the below given link for more guidence. Thank you. 

http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFAQ.pdf

Heidi Posted Mon 06th of March, 2017 11:53:14 AM
Sorry I think you read my question wrong THe pateint is in a long term facility left the facility came to office and saw physician and went back to facility same day it was just an office visit but since the patient at time is in long term facility the insurance company is saying they wont pay
SuperCoder Answered Tue 07th of March, 2017 05:52:27 AM

Hi Sherry,

As per consolidated billing MAC will not pay outside provider but SNF/LTC facility will pay. Use the office visit codes for new or established patient not the inpatient or nursing home codes, as per your documentation.

When services are furnished to an SNF/LTC resident covered by Medicare Part A and those services are provided by an outside provider, the SNF/LTC facilities can no longer unbundle those services and then submit a separate bill to the MAC.

Instead, the SNF/LTC facilities must furnish the services directly or furnish them through a contracted arrangement with the outside provider. The SNF/ LTC, rather than the provider of the service, bills Medicare. As a result, the outside provider of the service receives payment from the SNF, not the MAC. Please see the link for further assistence. Thank you.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/ConsolidatedBilling.html 

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