Otolaryngology Coding Alert

Question: A physician evaluates a new patient in an assisted living facility for sinusitis. Should we bill it as 99339 or 99340?

Washington Subscriber

Answer: Neither. Clearly, the patient received a face-to-face E/M service that was provided in a domiciliary or rest home environment. You should not confuse it with codes for care plan oversight (CPO) of a patient in a home, domiciliary, or rest home, which includes an assisted living facility (99339-99340). Instead, use E/M service codes for new-patient domiciliary, rest home, or custodial care services (99324-99328), depending on the documented level of the service.

Example: Suppose the physician visited the new patient in the assisted living facility and was able to assess the patient's medical condition and documented a problem focused history and problem focused examination and proceeded to treat and manage the patient using straightforward medical decision You would report it as 99324 (Domiciliary or rest home visit for the evaluation and management of a new patient ... Physicians typically spend 20 minutes with the patient and/or family or caregiver).