Learn 3 Vital New Nursing Facility Coding Principles
Published on Sun Jan 01, 2006
Welcome an annual assessment replacement code and expanded subsequent care levels in CPT 2006
CPT 2006 downgrades coding for nursing facility services from an advanced class to a basic-level class--and the standard E/M rules finally apply to these codes.
The current nursing facility services coding structure is atypical. -To choose the right series of codes, you have to determine whether the physician treated the patient for a substantial change or basic illness,- says Maria M. Torres, CPC, CMM, a coding consultant with Bermudez Medical Consulting in Tampa, Fla.
In 2006, you no longer have to make this distinction between comprehensive nursing facility assessments (99301-99303) and subsequent nursing facility care (99311-99313). CPT 2006 deletes these code families and replaces them with:
- three codes for an initial assessment, 99304-99306
- four new codes for the subsequent visits, 99307-99310
- a new code for the annual nursing facility assessment, 99318. CPT did not change the discharge codes (99315-99316, Nursing facility discharge day management -). 1. Base Initial Assessment on Key Components The nursing facility assessment code changes will make coding initial nursing facility care easier. -The current structure of the NF Services section of CPT is atypical and has been a source of confusion since its creation in 1992,- states the American Medical Directors- Association (AMDA) in its CPT Coding Change Request.
Old way: When a nursing home patient undergoes a substantial change that requires the family physician to issue a new treatment plan, you have to choose between three types of comprehensive nursing facility assessments, Torres says. Here is the 2005 breakdown:
- annual assessment--99301 (Evaluation and management of a new or established patient involving an annual nursing facility assessment -)
- assessment involving a major permanent change of status--99302 (Evaluation and management of a new or established patient involving a nursing facility assessment -)
- assessment at the time of facility (re)admission--99303 (Evaluation and management of a new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility ...). New method: Instead of determining the type of assessment, you-ll choose 99301-99303's replacement codes based on the initial nursing facility care's key components. The new assessment codes describe three levels of initial nursing facility service that are consistent with the initial hospital care codes- structure, according to the AMDA.
Assigning the new codes based on the same-level new hospital patient codes use should alleviate payment problems.-We had a difficult time getting physicians and payers to understand that each of the assessment codes represented a specific nursing facility service process,- says Dennis Stone, MD, MBA, CMD, chief medical officer for HomeQuality Management, a nursing facility company in Louisville, Ky.
99304-99306's bottom line: The initial nursing facility care codes (99304-99306) describe -Initial nursing facility care, [...]
