Cardiology Coding Alert

Question: We have two hospitals in our area with which we are affiliated. Both now have a skilled
nursing facility (SNF)/subacute, which we have to bill under a separate facility ID number for the particular hospital. My question is: Can I still use the appropriate inpatient hospital visit evaluation and management (E/M) codes, 99231-99233, or do I have to use an SNF visit code, 99312? What facility type do I use, hospital or skilled nursing facility? What are the limitations for Medicare patients on how many times the physician may see them?

Valley Cardiology Medical Group
Lancaster, CA

Answer: The cardiologist cannot use an inpatient hospital code for a skilled nursing facility because SNF/subacute care units are separate and distinct units in the hospital, says Georgeann Edford, RN, MBA, CCS-P, president of Coding Compliance Solutions, a physician reimbursement consulting firm in Birmingham, MI. The day the patient is discharged from the hospital must be noted if the patient was being followed as an inpatient.

Usually, the cardiologist will need to perform more than one comprehensive assessment of the patient during the inpatient confinement period (99231-99233, depending on the level of the assessment).

After discharge, the cardiologist then may bill for an initial nursing facility day, as well as for each subsequent care day using codes 99301-99303 for the initial day and 99311-99313 for subsequent nursing facility care, Edford says, again, depending on the level of E/M services the patient requires. She notes that Medicare allows physicians to bill for a discharge from the hospital (99238-99239) and also bill an admit to the nursing facility using 99301-99303.

Note: CPT codes 99315-99316 are used to report management of discharge from the nursing facility. For 30 minutes or less, use 99315; for more than 30 minutes, use 99316.