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Skilled Nursing Home Visits

Marita Posted Fri 11th of July, 2014 02:40:49 AM

The cardiologist I bill for visited an established patient in the skilled nursing facility. He consulted with the skilled nursing physician on staff re: patient care. Can he bill for this, and if so how do you properly code?

SuperCoder Answered Sun 13th of July, 2014 10:59:44 AM

Is cardiologist employed with SNF?

Marita Posted Mon 14th of July, 2014 19:01:28 PM

No, cardiologist is not employed by SNF.

SuperCoder Answered Tue 15th of July, 2014 08:38:59 AM

It seems that Care plan oversight codes are appropriate in this scenario.
You may use code 99379. It represents "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".

If your situation meets all the requirements listed below, you are eligible to bill for CPO services:

-The physician cannot have a significant financial arrangement with the home health agency or hospice that is providing care to the patient.
-The physician may not be an employee or medical director of the home health agency or hospice.
-Only one physician per month may bill CPO.
-Neither a physician who is billing for the end-stage renal disease services under a capitation arrangement nor a physician who is providing surgical follow-up in the global period may bill for CPO.
-The physician who bills for the CPO must be the same physician who signed the certification for the home health agency or hospice in the first place.
-The physician must have had a face-to-face service with the patient within six months of billing for the CPO.
-The physician must have personally provided at least 30 minutes of service in one calendar month.
-The beneficiary must be receiving Medicare covered home health or hospice services during the period in which CPO is billed.
-The beneficiary must require complex or multidisciplinary care modalities requiring ongoing physician involvement in the patient's plan of care.

Thanks !!

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