Primary Care Coding Alert

Question: A nursing-home patient transfers to a different nursing home but remains under the same family physician's care. How should I code the established patient, new admission encounter?

Pennsylvania Subscriber

Answer: To cover the services associated with the admission to the second nursing home from the first nursing home, you should submit 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 ...).
 
Neither CPT nor the Medicare manuals explicitly address nursing-home transfers. But if you apply CPT's notes for comprehensive nursing-facility assessments to your situation, 99303 seems appropriate. With the exception of hospital discharge or observation discharge services, the admitting physician should include the services related to the admission that he provided in other sites of service including a nursing-facility setting in 99301-99303, CPT states.