Wiki What CPT codes should we be using for patients already admitted to a LTCF?

[allison_w_99]

So in our area we have a LTCF that is affiliated with the area hospital. On the website it refers to itself as a "LTACF". The patients are very sick and have multiple chronic, serious problems so in most situations our specialists will do a consult while they are an inpatient and continue to monitor the patient every day. They may schedule a procedure at the hospital the facility is affiliated with on the same day the consult is done. The POS is 61 I believe. When I started at this practice, I noticed that coding staff was posting the procedures with an outpatient POS for the hospital and the consult with the same POS if they were done on the same day. Then we were billing 99231-99233 for the monitoring. This seems wrong to me because they have already been admitted to the facility. I asked about the rationale for this and was told this is because these procedures are scheduled as an outpatient at the hospital.

I believe we should be using 99304-99310 if we do a consult or monitor the patient in the LTCF with a POS of 61 even if an outpatient procedure is done on the same day as the consult. Since the procedures are done at the hospital and they are not admitted to that hospital, I would conclude that an outpatient POS IS what should be listed on the claim for this portion of the service but should still use the inpatient nursing code for the consult. Am I correct? If so how can I prove this to my coworkers?

Please help! So confused...

 

[mitchellde]

Check your Medicare regs. You use the POS for where the patient is registered regardless of where the service takes place. So if they are registered as a long term care patient, even if the service occurs at the outpatient hospital, the POS remains the long term care.

 

[allison_w_99]

Check your Medicare regs. You use the POS for where the patient is registered regardless of where the service takes place. So if they are registered as a long term care patient, even if the service occurs at the outpatient hospital, the POS remains the long term care.

Thank you so much for your reply! I checked the Medicare regulations, chapter's 12 and 26 so now I have the rationale to show my coworkers. This will clear up a lot of confusion for us.