Primary Care Coding Alert

CPT 2008 reworks definitions for 99304-99310 Good news for coders: CPT has revised the definitions for nursing facility care in its 2008 edition, which makes coding for these services much easier. Impact: CPT previously did not include typical times for 99304-99310 and 99318 for coders to observe. The codes were distinguished only based on the key components (i.e., history, exam, and medical decision-making) and severity of the problem or the patient's status. Now, each nursing facility care entry includes a typical timeframe for that level of visit. Check Last Sentence for Time Guideline Here's the new definition of 99304: Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision-making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. The last sentence of the definition, which provides a timeframe for 99304, was not part of the descriptor last year. "This change is a help to coders," says Quinten Buechner, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis. Benefit: The rewritten codes will make the prolonged services codes easier to report. However, "the trick is getting the physicians to document the time spent in counseling and coordination of care," he says. The other revised codes in the nursing facility section of CPT 2008 are: - 99305 -- - a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver. - 99306 -- - a comprehensive history; a compre- hensive examination; medical decision-making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver. - 99307 -- Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; straightforward medical decision- making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature [...]