Wiki Initial Nursing Facility Visit 99304-99306

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stephanieb

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I work in a long term care facility and have a question on the initial nursing facility care visit, E/M codes 99304-99306. My question is: Does the Initial Nursing Facility Care visit need to be on the same day as admission. The new physician in my facility seems to think that we are able to bill these codes, even though she does not see the patient (face-to-face) on the day of admission. She will write the admission orders on the day of admission, but waits to do the H&P until the following day, or up to the following 30 days. Can someone help me clarify this?
 
These are "Per Day" codes

I have been coding inpatient and outpatient visits for about five years. While I have never used this set of codes previoulsly, notice that these codes are used "Per Day". Which means that you cannot take the key components from multiple dates and add them up or the floor or unit time either. They are "Per Day".
 
Let me pick your brain a little bit more and give you the gory details. The physician is admitting this patient from the hospital, writing the admission orders on the day of admission, then seeing the patient for H&P the day after or maybe 2 days later. As I read the definition of initial visit, it says it needs to include a thorough assessment, develop a plan of care and write or verify admitting orders. I just want to be sure if those 3 elements aren't being done on the same day, then I shouldn't bill for the initial visit.

One more question, what about the transfer of care to another physician? Would I be able to bill initial visit for those?

Thanks for your input!



I have been coding inpatient and outpatient visits for about five years. While I have never used this set of codes previoulsly, notice that these codes are used "Per Day". Which means that you cannot take the key components from multiple dates and add them up or the floor or unit time either. They are "Per Day".[/QUOTE]
 
stephanieb said:
Let me pick your brain a little bit more and give you the gory details. The physician is admitting this patient from the hospital, writing the admission orders on the day of admission, then seeing the patient for H&P the day after or maybe 2 days later. As I read the definition of initial visit, it says it needs to include a thorough assessment, develop a plan of care and write or verify admitting orders. I just want to be sure if those 3 elements aren't being done on the same day, then I shouldn't bill for the initial visit.

One more question, what about the transfer of care to another physician? Would I be able to bill initial visit for those?

Thanks for your input!"




I just came across a great article about this a couple days ago...don't remember where, but I will try to backtrack to it.

In a nutshell, the physician is not required to perform the Initial E/M Service on the same day the patient is "admitted" to a facility. If the E/M is not done until a day or 2 later, use the day that it was actually performed as the DOS, even if it doesn't match the admit day.

I hope I can find more info for you; I see this question asked often.

Can you give more info on your "Transfer of Care" question?

Hope this helps for now!
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