EM Coding Alert
Follow the 3 Key Components Rule for 99304-99306
Question: How do I code if our physician went to the nursing home to see Medicare patients for consultations, but did not meet all three requirements to charge a new patient visit. Would I use 99307?
Answer: The codes for nursing home consultations are 99304-99306 (Initial nursing facility care, per day for the evaluation and management of a patient ...). However, these codes do require that the three key components — history, physical examination, and medical decision making — be addressed. Since you did not do the three components, you cannot bill these codes.
Under these circumstances most Medicare carriers require unlisted code 99499 (Unlisted evaluation and management service) and request to see all of your provider’s documentation. Then the carrier will reimburse as they see fit based on your documentation.
For commercial and private carriers, you may be able to use 99307 (Subsequent nursing facility care per day, for the evaluation and management of a patient...) as you suggested.
EM Coding Alert
- Time-Based Coding:
Ensure Your Provider is Documenting 3 Key Points for Billing on Time Alone
Remember that counseling and coordination of care must dominate the encounter. If you’re coding office [...] - Back to Basics:
Pay Attention to 3-Year Rule to Decide Between New vs. Established Codes
The location of the encounter won’t be the deciding factor. Even before you start looking [...] - Clip and Save:
Follow this 5-Question Path to Find Out if the Patient is Really New
This tool will help you navigate the sometimes tricky new vs. established question. As noted [...] - You Be the Coder:
New Patient Vitals Won't Make the 99203 Grade
Question: A new patient presented in our office. Past medical, social, and family history were [...] - Reader Question:
Modifier 25 is Your E/M + Procedure Answer
Question: Can I bill Medicare for an office visit and cystoscopy on the same day [...] - Reader Question:
Capture Payment For Biopsy Result Discussion
Question: A patient came in for the biopsy report after a 90-day global procedure. The [...] - Reader Question:
Ensure Providers Indicate ROS Review
Question: I’ve heard that for an E/M visit, the physician is responsible for certain parts [...] - Reader Question:
Remember Prolonged Service Codes for Extra Long Visits
Question: My pediatric physician spent 105 minutes with a new patient in the office. Is [...] - Reader Question:
Follow the 3 Key Components Rule for 99304-99306
Question: How do I code if our physician went to the nursing home to see [...]
