Pulmonology Coding Alert

Question: We recently began referring patients to nursing facilities and also providing E/M services to the patients once they are admitted. How should we report the nursing-facility services codes?

Arkansas Subscriber Answer: The most common misconception about comprehensive nursing-facility assessment codes (99301-99303) is that they're structured the same way as the outpatient E/M series (99201-99215), with each code
reflecting an increasing level of service. But these codes represent three different services - and level of service is not relevant. Use this primer on nursing-facility assessment codes:

 Report 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 a comprehensive history and examination, and medical decision-making of moderate to high complexity) when the nursing home first admits the patient and the pulmonologist creates a medical plan of care.

Note: Also use 99303 when the physician readmits a patient to the nursing home after the physician initially discharged the patient.  Report 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) if the pulmonologist performs an annual evaluation.  Report 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) when the patient "has developed a significant complication or a significant new problem and has had a major permanent change in status," according to CPT 2004.

Remember that this permanent change in status requires you to revise the care plan.

If the pulmonologist doesn't sign the admitting orders, establish the plan of care, and take responsibility for the patient's entire medical care throughout the length of stay, then your physician cannot report the nursing-facility codes.