Practice Management Alert

Here's the Latest on New LTC Codes

Good news for long-term care billers: New 2006 codes in the Nursing Facility Services and Domiciliary, Rest Home or Custodial Care Services sections are -much more clearly defined than the old codes,- says Kathy Pride, CPC, CCS-P, a consultant with QuadraMed in Port St. Lucie, Fla. Billers should be familiar with these changes:

Change #1: Nursing Facility Services adds a new subsection and codes. CPT 2006 introduces an Initial Nursing Facility Care subsection, which contains new codes 99304-99306 (Initial nursing facility care, per day ...). This new code set replaces the 99301-99303 code set.

The old codes were based on the type of nursing facility assessment the physician made, -whereas the new codes are based on the three key components: history, exam and medical decision-making,- Pride says.

What this means for you: From now on, you-ll need to report nursing facility and skilled nursing facility (SNF) admissions by evaluating the physician's documentation of the history, exam and medical decision-making (as you would any other E/M service) and choosing the appropriate level of service from 99304-99306.

Change #2: The Subsequent Nursing Facility

Care subsection gets new codes and level of service. CPT 2006 deletes codes 99311-99313 and replaces them with 99307-99310 (Subsequent nursing facility care, per day, for the evaluation and management of a patient ...) for subsequent nursing facility care. These new codes do not have a time component. Further, the code set added 99310, which creates a fourth level of service.

What this means for you: Now you will be able to evaluate all subsequent nursing facility care services according to four possible levels of E/M service.

Change #3: New annual assessment code 99318 finds a  home in the Other Nursing Facility Services subsection. The law mandates that all nursing home patients have an annual assessment, says Gary Phillips, a SNF management and operations consultant with BKD Health Care Group in Springfield, Mo. The creation of new code 99318 (Evaluation and management of a patient involving an annual nursing facility assessment ...) sets this annual assessment service apart from other nursing facility E/M services by placing the code in a new subsection: Other Nursing Facility Services.

What this means for you: Code 99318 replaces code 99301 (Evaluation and management of a new or established patient involving an annual nursing facility assessment ...), so don't select that now-deleted code by mistake when your physician renders an annual assessment, Pride says.