Primary Care Coding Alert

Question: One of our longtime patients now lives in a skilled nursing facility. She wants to continue visiting our office although the nursing facility has physicians who would see her. Can we still see her, and, if so, do we bill anything differently?

Maryland Subscriber/

Answer: Yes, she can still see your physicians in their office, and you should bill her visits as usual. Complications might arise, however, with any diagnostics your physicians run while she's in the office (such as EKG or spirometry tests). Because she's a skilled nursing facility resident, she falls under guidelines for the Consolidated Billing for Nursing Homes. That means Medicare pays the nursing facility for the technical portion of certain diagnostic tests. Learn what diagnostics the guidelines cover so you can accommodate with your billing.

Example: The patient has an EKG in your office. You should report 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) to Medicare. Send the nursing facility a bill for 93005 (... tracing only, without interpretation and report) so they can pay your physician for his service.

You would handle spirometry tests in a similar way, but include modifiers to distinguish your physician's role. Bill Medicare with 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and append modifier 26 (Professional component). Bill the nursing facility with 94010-TC (Technical component).

Another note: Your physician can also see her in the nursing facility. If so, bill with the nursing home codes (including 99304-99306 for initial care and 99307-99310 for subsequent care) and location (place of service 31, Skilled nursing facility).