Primary Care Coding Alert

Question: A family physician treats a patient in the office who has Part A skilled nursing facility benefits. How should I code for the service?


New Jersey Subscriber


Answer: You should code the E/M service the same way you would for an outpatient. Assign the appropriate-level outpatient new or established office visit code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient -).

Even though services and procedures for SNF patients may fall under Medicare Part A coverage, physicians- services and the professional components of certain diagnostic procedures are exempt from consolidated billing. Therefore, you can report the office visit to your Medicare Part B carrier.

If the FP evaluates the patient at the facility, rather than at the office, you should instead code a nursing facility service. For a comprehensive assessment, use 99301-99303 (Evaluation and management of a new or established patient -). Assign a code from 99311-99313 (Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient -) for subsequent nursing facility care.

When reporting 99301-99313, you should enter place of service (POS) code 31 (Skilled nursing facility) in box 24b of the CMS-1500 form. Include the SNF's address and Medicare provider number in box 32.
 
Don't overlook: You may have to work out payment with the SNF if the service falls under Part A coverage. For instance, a patient receives physical therapy services, such as therapeutic exercises (97110) or massage therapy (97124), at your office. Medicare considers both of these services Part A coverage included in the SNF's consolidated billing. Therefore, you would have to bill the SNF for the physical therapy service.