Wiki Initial Nursing Facility Services (99304-99306) Question

[sefton.karen@davishealthsystem.org]

At the facility where I work, we have a family practice provider seeing patients in a nursing home. The question has arisen as to whether or not it is appropriate to use an Initial Nursing Facility E/M when the patient is re-admitted to the nursing home after being discharged as an inpatient or observation stay. For example, Dr. C saw Fred at the nursing home on 5/1/24. Fred was sent to the hospital on 5/15/24 and stayed for 4 days. He was discharged from the hospital on 5/18/24 back to the nursing home. Dr. C sees Fred in the nursing home on 6/1/24 and wants to use the Initial Nursing Facility Care E/M. Would this situation be considered an initial visit or subsequent because Dr. C has already seen the patient in the nursing home on 5/1/24?

Thank you for any guidance!

 

[Cls1530]

Nursing facility services are considered to be similar to inpatient services. It is based upon the admit and not if the patient is established to the provider. Per coding guidelines in the CPT, the initial services codes can be used once per admit, per physician.

 

[sefton.karen@davishealthsystem.org]

Nursing facility services are considered to be similar to inpatient services. It is based upon the admit and not if the patient is established to the provider. Per coding guidelines in the CPT, the initial services codes can be used once per admit, per physician.

Thank you, I appreciate the clarification!

 

[ccombs@physicianhealthcare.com]

Hello!

I am new to nursing home coding--I was wondering if the patient was discharged from the SNF of 03/21/2024 and then went into the hospital on 5/28/24 discharged from the hospital back to the SNF and my provider saw the patient on 6/5/2024...is that considered an initial visit? I cannot find guidelines regarding about this since my provider is a family doctor and make rounds at the nursing home.

 

[sefton.karen@davishealthsystem.org]

Hello!

I am new to nursing home coding--I was wondering if the patient was discharged from the SNF of 03/21/2024 and then went into the hospital on 5/28/24 discharged from the hospital back to the SNF and my provider saw the patient on 6/5/2024...is that considered an initial visit? I cannot find guidelines regarding about this since my provider is a family doctor and make rounds at the nursing home.

Based on the previous reply, I would consider this an initial visit. I would use the explanation at the beginning of the code set (99304-99306) in the CPT book as your guideline to who can and cannot see the patient. Hope this helps!