Practice Management Alert

Question: Sometimes, my physician will conduct care plan oversight (CPO) in an assisted living facility. He also provides CPO in nursing facilities. Is there a difference in how to bill for CPO provided in the assisted living facility versus the nursing facility?


Connecticut Subscriber

Answer: There are new codes to make CPO billing more specific to site of service. After using the same codes for CPO regardless of setting for years, CPT 2006 adds a pair of codes to make reporting these services more specific.

To report care plan oversight services for nursing facility patients, choose either 99379 (Physician supervision of a nursing facility patient [patient not present] ... ; 15-29 minutes) or 99380 (- 30 minutes or more).

If the physician provides CPO in a domiciliary, rest home (e.g., assisted living facility), report the service with either 99339 (Individual physician supervision of a patient [patient not present] in home, domiciliary or rest home [e.g., assisted living facility] ... ;15-29 minutes) or 99340 (- 30 minutes or more).

Official explanation: According to CPT Changes 2006, -Codes 99339 and 99340 are intended to report care plan oversight services of children and adults with special healthcare needs and chronic medical conditions provided by primary-care physicians who coordinate the medical care and management with other medical and nonmedical service providers and family.-

Consider this example offered by CPT Changes 2006. Your physician oversees the ongoing care of a 20-year-old Down's syndrome patient who lives with his family and has hypothyroidism and auditory problems. If the physician adequately documents 25 minutes in a one-month period that he spent reviewing test results, consulting with other medical providers and discussing care plans with the family, you could report 99339 for that month's care plan oversight services.