Primary Care Coding Alert

Question: My family physician sees an inpatient who is awaiting nursing home placement. Should I use a hospital care code or a nursing facility service code?


Kansas Subscriber

Answer: You should choose the E/M code based on the patient's status at the time the FP saw the patient. If the patient is a hospital inpatient whom the FP has not yet discharged from the hospital, you should continue to report the appropriate hospital care code, 99221-99236.

When the FP treats the patient in a nursing facility including a skilled (SNF), intermediate (INF) or long-term (LTCF) facility, you should use a nursing facility service code (99301-99316).

If the FP provides hospital discharge services and nursing facility admission services to the patient, you should report both a hospital discharge code (99238-99239) and a nursing facility admission code, such as 99303.