Primary Care Coding Alert

Question: A new patient in an assisted living facility was treated for hypertension by the visiting physician. Can we still report this with 99339 or 99340?

Minnesota Subscriber

Answer: The domiciliary or rest home service done by the physician in this example clearly is an E/M service and should not be confused with codes for care plan oversight (CPO) of a patient in a home, domiciliary, or  rest home, which includes an assisted living facility (99339-99340). Instead, use E/M service codes for new-patient domiciliary, rest home, or custodial care services (99324-99328), depending on the level of the service.

In your example, suppose the physician visited the new patient in the assisted living facility and was able to assess the patient's medical condition from a problem focused history and problem focused examination and proceeded to treat and manage the patient using straightforward medical decision making all in 20 minutes. It would be appropriate to report this as:

• 99324 -- Domiciliary or rest home visit for the evaluation and management of a new patient ... Physicians typically spend 20 minutes with the patient and/or family or caregiver.

If the physician provides a higher level of service than the above example, then use the other applicable newpatient codes for this category from 99325-99328.

Here's a table of the key components to help you choose the level of the E/M service done. If the patient is an established patient and not a new one as in the prior example, then the corresponding E/M service codes to use will be those for established-patient domiciliary, rest home, or custodial care services (99334-99337).