# Subsequent Nursing Facility



## cdury (Feb 16, 2012)

I had 2 Dr.'s tell me that I was wrong today...I told them that some of the dictation was not billable because there not an exam documented. ...Basically all that was documented  was a history of a chronic problem & review of meds. I explained that when billing subsequent nursing facility visits, the Dr. must perform & document 1)History, 2)Exam & 3)Medical Decision Making.  They seem to think that the only have to perform 2 of the 3 components. I am having a hard time explaining that the "2 of 3" means the levels not the actual componenets...Or am I actually wrong? 
Second guessing myself big time!!


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## mitchellde (Feb 16, 2012)

No the subsequent nursing facility codes requires only 2 of the 3 key components be documented that 2 of the three being
1- history
2- exam
3- decision making
this means from the documentation that the lowest of these three may be discarded and of the 2 components left the lowest of those will determine the visit level.  
If only 2 of the three are documented then the lowest of the two determines the visit level.


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## cdury (Feb 16, 2012)

Thanks for your response.  I understand that the lowest two determine the level of the visit but does that also mean that the Dr. doesnt even need to perform an exam as long as the the other 2 components are documented? Im used to seeing all 3 components at a pretty decent level (at least from these 2 Dr.'s) but today had 1 dictation that was only 2 short sentences. And approximately 3 or 4 other dictations with a bit more information but no exam...2 had only "resolved &/or probable" diagnosis. There wasnt enough information provided to even code symptoms.   
I guess I'm just not used to seeing so little documentation from these two Dr.'s and I cant recall ever receiving a dictation without an exam.


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