Drill Down – Evaluation and Management Coding in Skilled Nursing Facilities

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Original story posted on: December 2, 2013


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RAC Region A contractor Performant posted a review issue for Physician/Non-Physician Practitioner provider types regarding Evaluation and Management Coding in Skilled Nursing Facilities. The states listed for this audit issue are CT, MA, ME, NH, NY, RI, and VT.

Per the contractor’s description of this issue:

When evaluation and management (E/M) services are provided to patients in a Skilled Nursing Facility (SNF), CPT codes 99304-99318 should be reported. It is inappropriate to report hospital inpatient care codes (99221-99223, 99231-99233, 99238, and 99239) for SNF E/M services.

The contractor references the CMS Pub-100-04, Medicare Claims Processing Manual, Chapter 12, Sections 30.6.13 and 30.6.14, which define SNF place of service and appropriate E/M codes:

Beginning January 1, 2006, the new CPT codes, Initial Nursing Facility Care, per day, (99304-99306) shall be used to report the initial federally mandated visit. 

Beginning January 1, 2006, the new CPT codes, Subsequent Nursing Facility Care, per day, (99307-99310) shall be used to report federally mandated physician E/M visits and medically necessary E/M visits.

Beginning January 1, 2006, the new CPT code, Other Nursing Facility Service (99318), may be used to report an annual nursing facility assessment visit on the required schedule of visits on an annual basis. 

RAC Issues for the Week of November 25 – November 29, 2013:

RAC Region A Performant

Physician/Non-Physician Practitioner

  • Evaluation and Management Coding in Skilled Nursing Facilities – JK - When evaluation and management (E/M) services are provided to patients in a Skilled Nursing Facility (SNF), CPT codes 99304-99318 should be reported. It is inappropriate to report hospital inpatient care codes (99221 - 99223, 99231-99233, 99238, and 99239) for SNF E/M services.

About the Author

Dr. Margaret Klasa is the medical director for Context4 Healthcare. She is responsible for the company’s business knowledge discovery unit for medical context as it relates to the daily development of data products and software for medical claims editing and coding with an emphasis on clinical and regulatory guidelines for Medicare and Medicaid and commercial payers. 

Contact the Author

Margaret.Klasa@context4.com

To comment on this article please go to editor@racmonitor.com

 

Margaret Klasa, DC, APN, Bc

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