Primary Care Coding Alert

Comprehensive nursing facility assessments (99301, 99302 and 99303) have been known to confound the most expert coder because they dont always follow the same rules that govern other evaluation and management (E/M) codes.

There are a number of issues that make these codes unusual, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a national healthcare consulting firm specializing in financial and healthcare management with a focus on physician compliance, coding, billing and reimbursement based in Lansdale, Pa. Coders must be alert to these key differences to assign them correctly. This is especially important given the high relative work values assigned to these codes. Correct coding can make a significant difference in the level of reimbursement received.

The definitions and relative value units (RVUs) for these codes are:

99301 evaluation and management of a new or established patient involving an annual nursing facility assessment which requires these three key components: a detailed interval history, a comprehensive examination, and medical decision making that is straightforward or of low complexity (30 minutes at the bedside), 1.767 RVUs;

99302 evaluation and management of a new or established patient involving a nursing facility assessment which requires these three key components: a detailed interval history, a comprehensive examination, and medical decision making of moderate to high complexity (40 minutes at the bedside), 2.309 RVUs; and

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, which requires these three key components: a comprehensive interval history, a comprehensive examination, and medical decision making of moderate to high complexity (50 minutes at the bedside), 3.068 RVUs.

Each of the three codes describes initial and annual assessments (admission and readmission activities) a family physician would provide for patients being cared for in a nursing facility. These are complex evaluations because they not only appraise a patients medical condition but consider psychosocial functions as well, Falbo explains. Because the patient lives in the nursing facility, the scope of care is much broader. The family physician will play a central role in coordinating and overseeing a multidisciplinary treatment plan. Use these four key factors in determining how to code nursing facility assessments:

1. Assign 99301, 99302 and 99303 for services provided to both new and established patients. There is no distinction between new and established patients with these codes, Falbo notes. This is something that often trips up coders. They want to apply the same rules they use with consultations or outpatient visits one series of codes for new patients, and another for established. This rule of thumb doesnt apply with nursing facility assessments.

Note: Adding confusion to [...]