Neurology & Pain Management Coding Alert

Comprehensive nursing facility assessments (99301-99303) do not always follow the same guidelines that apply to other E/M services, making them a challenge for many coders and physicians. By keeping in mind four simple points, you can assign these codes with confidence, report services properly and receive the reimbursement you deserve. Comprehensive Truly Means Comprehensive A nursing facility assessment is a complex evaluation encompassing every aspect of the patient's care (not just the complaint-specific evaluation that comprises the typical "sick visit"). The in-depth evaluation considers the patient's nutritional and psychosocial status, his or her functional status and impairments, and the rest of his or her complete medical profile. Any facility providing convalescent, rehabilitative or long-term care must perform an assessment each time a patient is admitted to the facility, as well as annually thereafter or anytime the patient's condition undergoes a major permanent change. A neurologist may be called on to provide these services for nursing facility patients, including those suffering from strokes (436), multiple sclerosis (340), paraplegia (344.1) and other conditions with psychological and/or neurological manifestations. In particular, the neurologist works with the patient's other caregivers, such as dietitians; physical, occupational and speech therapists; and psychologists to create a full picture of the patient's condition so his or her plan of care can be written for the following year. CPT provides three codes to describe these services, each of which has a unique application:
99301 Evaluation and management of a new or established patient involving an annual nursing facility assessment ...
99302 Evaluation and management of a new or established patient involving a nursing facility assessment ...
99303 Evaluation and management of a new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility ... Point 1: Patient 'Status' Doesn't Matter The first point to remember when choosing a comprehensive nursing facility assessment code is that, unlike many other E/M services, these codes do not differentiate between "new" and "established" patients. Whether the physician has attended to the same patient within the last three years makes no difference. The assumption is that the physician must perform the same high-level evaluation regardless of how well he or she knows the patient. This is in contrast to office visits, for example, when codes for an established patient at a given level are valued less than those for a new patient at the same level (for example, 99213 has been assigned fewer relative value units than 99203) because CMS assumes that evaluation of an established patient is less intensive due to the physician's familiarity with the patient. Point 2: Code by Chart and Circumstances Comprehensive assessment codes encompass very specific components. For instance, when [...]