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Coming Your Way Soon: Pre-Pay Edits for Nursing Facility E/Ms?

Published on Sun Jan 10, 2010

Check out this advice on 'split' CC visits. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One Medicare administrative contractor (MAC) recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it had recently audited claims for code 99310 (Subsequent nursing facility care, per day), and found that only 13 percent of these claims were actually billed correctly. Based on the outcome of the audit, NGS said that it "will be implementing a prepay edit for CPT code 99310." Know these quick facts before you report this nursing facility care code in the future: 1. Check documentation for comprehensive interval history, comprehensive exam, and/or high-complexity medical decision making. CPT requires documentation of at least two of these criteria before you can bill [...]
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