Neurology & Pain Management Coding Alert

Question: Would you clarify what separates a nursing facility from a domiciliary, rest home, or custodial care facility? Would you also provide some guidelines for how to use the new codes for rest home care? 


Arizona Subscriber

Answer: The rest home, domiciliary or custodial care facility (POS 33), as defined by both CPT and CMS, -provides room, board and other personal assistance services, generally on a long-term basis.- Such facilities do not have a medical component. This is the factor that distinguishes them from a nursing facility (POS 32).

You should choose from among the new domiciliary, rest home, or custodial care codes (99324-99337) in the same way that you would select other office outpatient visit codes (99201-99215).

For instance, to report the lowest-level new patient visit in a rest home (99324), your physician will need to document a problem-focused history, problem-focused examination and straightforward medical decision-making (MDM)--exactly the same requirements for a level-one E/M service for a new patient visit in the office (99201, Office or other outpatient visit for the evaluation and management of a new patient). 

It takes three: As with the new patient office/ outpatient visits, you must meet all three requirements to report a given level of service with new patient custodial care codes 99324-99328.