Are you ready to dive into billing and coding in nursing facilities? From fundamental to complex billing and coding operations, you’ll learn here.
We’ll also talk about recent industry developments and how you may ensure your facility complies with all laws and regulations. So, let’s begin our journey to comprehend billing and coding in nursing facilities!
Nursing Facility Codes Under New or Established Patient – Evaluation and Management
CPT code 99304
The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves straightforward or low medical decision-making, or the provider spends at least 25 minutes on the encounter on a single date.
CPT code 99305
The provider performs evaluation and management during the patient’s initial nursing facility care visit (E/M). The physician spends at least 35 minutes on the interaction during the visit, including moderate medical decision-making.
CPT code 99306
First-time evaluation and management (E/M) by a physician in a nursing facility. If a physician spends more than 45 minutes on a visit or makes complex medical decisions.
Under Subsequent Nursing Facility Care
CPT code 99307
The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision-making, or the provider spends at least 10 minutes of total time on the encounter on a single date
CPT code 99308
The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves low medical decision-making, or the provider spends at least 15 minutes on the encounter on a single date.
CPT code 99309
Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically involving a detailed history and examination.
CPT code 99310
A provider conducts an evaluation and management (E/M) visit with a patient at a nursing home. The practitioner spends at least 30 minutes on the contact, or the visit requires some degree of medical decision.
Nursing Facility CPT Codes Under Telephone Services
CPT code 99441
This code denotes a 5-to-10-minute telephone evaluation and management service by a trained non-physician healthcare provider. It’s used when a doctor calls a patient to assess and monitor their health, provide advice, answer requests, or discuss options for treatment. Physician assistants and nurse practitioners must perform the service.
CPT code 99442
A qualified non-physician healthcare practitioner provides an 11–20-minute telephone evaluation and management service under this code. It covers a more extended duration of telephone consultation compared to code 99441. Like 99441, it involves assessing and managing the patient’s health condition over the phone and providing appropriate guidance, support, and recommendations.
CPT code 99443
This code represents a telephone evaluation and management service provided by a qualified non-physician healthcare professional that lasts between 21 and 30 minutes. It covers a longer telephone consultation duration compared to 99441 and 99442. The healthcare professional spends more time interacting with the patient, discussing their medical concerns, reviewing their symptoms, and providing more comprehensive guidance and support.
Under Nursing Facility Discharge Services
CPT code 99315
CPT code 99315 refers to Nursing Facility Discharge Services. This code represents nursing facility discharge medical services. The healthcare provider handles the patient’s discharge under this code.
CPT code 99316
The Nursing Facility Discharge Services CPT code is 99316. These services include a thorough evaluation and medical care of a patient leaving a nursing facility. The code covers the medical coordination and decision-making necessary for the patient’s return from the nursing facility to their home or another care setting.
Under Care Plan Oversight Services
CPT code 99374
When a healthcare professional observes a patient’s care plan at home or in a long-term care facility, they should report this service. The provider for 99374 should devote at least 15 to 29 minutes to the indirect care of a patient.
CPT code 99379
When the provider oversees the care plan and the care given in a nursing facility, you ought to submit this service. The physician should dedicate 15–29 minutes to the patient’s indirect care for 99379.
CPT code 99380
In cases where the provider oversees the care plan at a nursing home, the service should be reported. Indirect treatment for patient 99379 requires at least 30 minutes of provider time.
HCPCS code for Nursing Facility
HCPCS code G0180
The expert assessment and management services rendered during the home visit are covered under the G0180 HCPCS code. It helps in the appropriate documentation and billing of this specific service by healthcare providers and insurance firms. Healthcare practitioners may guarantee adequate service payment while maintaining transparent billing procedures using the G0180 code.
HCPCS code G0128
The direct skilled nursing services a registered nurse provides in a comprehensive outpatient rehabilitation facility are reported using the HCPCS code G0128. This code represents the face-to-face interaction between the nurse and the patient. The initial 5 minutes of the service are not separately billable, so any additional time spent beyond the initial 5 minutes should be reported using different units of G0128.
HCPCS code G0317
G0317 is used for prolonged nursing facility evaluation and management services. This code is designed explicitly for reporting additional time spent by a healthcare provider in evaluating and managing a patient in a nursing facility.
HCPCS code Q5004
The code for hospice care provided in a skilled nursing facility (SNF) is Q5004.
HCPCS code T1020
The code for personal care services provided per diem and not for an inpatient, hospital, or nursing facility resident is T1020.
Conclusion
In conclusion, healthcare providers need to understand nursing facility billing and coding to provide the best treatment. By knowing the process, nurses may offer the best treatment and maintain accurate and up-to-date billing and coding practices. Nurses can provide the most effective care by knowing billing and coding procedures.