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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 

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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2016-11-20T23:38:46+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

One Comment

  1. Julia August 30, 2013 at 10:24 am - Reply

    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.

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