Medical Coding Question: How To Code For Nursing Home Visits

Medical Coding Questions: CPT Nursing Facility Services. This one is Alicia’s.

Diane asked, “Nursing home resident monthly visit note. If you’re seeing a resident for their required visit… and the keyword there is ‘required’… the MD says, “No complaints, nothing acute.” How can you code this? I think you have all sorts of diagnoses, all sorts of medication and just say, “Will continue current meds. Will follow routinely.” The company expects me to bill them but where’s the medical necessity except for the fact that is a required visit by Medicaid/Medicare.

Medical Coding Question: How To Code For Nursing Home Visits 

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Well, when you’re doing a skilled facility, it’s required for the doctor to come in and evaluate routinely the patient. So he gets paid for that and the code range for that is in nursing facility services. It’s an E&M code. They’re 99304 through 99318. And the key is ‘provides continuous healthcare service to patients who are not actually ill’. But they do get paid for coming in and visiting and examining that patient. So you have some choices that I picked out. “Stable, recovering or improving” which, for this example, would be the perfect code, 99307 because the patient’s stable. They’re not making any changes. They’re recovering or they’re improving. And then you have other choices: not responding or minor complications, significant complications or new problems, significant new problem: require immediate physician attention.

So there are codes for that and they are expected. That’s why they’re wanting you to bill for that. Another medical coding question answered!

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7 thoughts on “Medical Coding Question: How To Code For Nursing Home Visits”

  1. We are just now coding for our facility. What codes would we use for initial psych eval on admit? Would it be 90791-90792 or would it be 99304-99306? I’m completely confused on this issue.

  2. How do I code telepsychiatry for nursing home patients? Do I use the in office codes since the physician never leaves the Psychiatry office or do I use nursing home codes that are used when the physician goes to the nursing home facility? Thanks!

  3. When a patient is admitted into a nursing home under POS 31 (short term care) and transferred over to POS 32 (long term care) does there need to be a CPT code 99315 to discharge from POS 31 and admit to POS 32; or do we just change the POS when billing?

  4. If pt. has a medicare advantage plan the services were rendered at the pt’s home. Which nursing codes can I bill the payer? The payer just denied the claim because they follow medicare guidelines and they require medicare codes for the nursing services, which ones can I use? The payer denied codes 99601 and 99602.

    • Sorry, but “How Do I Code/Bill” questions are not answered on the blog. That benefit is reserved for CCO Club members. We do hope you’ll consider joining the CCO Club so you can take advantage of that benefit along with many others.


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