Internal Medicine Coding Alert

The complexity of the nursing home codes has prompted MeritCare Health Systems, a North Dakota multispecialty system, to develop a card that physicians carry in their pockets to assist with proper coding.

The large 4"x 6" laminated index card lists all six nursing home codes and the two discharge codes, along with their descriptions from the CPT manual. To make it easy for physicians to select the proper code, MeritCare bold-faced the key components that differentiate each code and, where appropriate, the requirement that a new care plan be developed.

Jean Ryan-Niemackl, LPN, CPC, compliance analyst for MeritCare, says the cards have reduced physician confusion about the requirements for each of the codes. Formerly, physicians may have coded 99312 when the "nature of the presenting problem" only substantiated a 99311. At the same time, few used 99313 when appropriate because they were unsure of the documentation required.

"They [physicians] can look at it [the card] and see: This is when you code an annual physical. Or, when your patient is stable, recovering or improving, you can document a book, but it's still a 99311," Ryan-Niemackl says.