Cardiology Coding Alert

Question: Our doctors were asked to consult at a nursing home. They have never gone before, and I’m not sure what codes to use. When I looked in the book, the codes 99304-99310 for nursing facility visits state they are for the admitting physician, initial care, and subsequent care. Since we are specialists, can we use these codes as well?

Codify Member

Answer: Specialists may report the nursing facility codes you mention. You also want to be sure you use the appropriate place of service code. For more details, check out Medicare Claims Processing Manual, Chapter 12, Section 30.6.13, at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf.

In the manual you’ll find helpful information such as how the use of modifier AI (Principal physician of record) distinguishes the principal physician’s claim from those of other specialty care physicians: "The principal physician of record must append the modifier ‘-AI’, (Principal Physician of Record), to the initial nursing facility care code. This modifier will identify the physician who oversees the patient’s care from other physicians who may be furnishing specialty care. All other physicians or qualified NPPs who perform an initial evaluation in the NF or SNF may bill the initial nursing facility care code."