Group Practice Provider Seeing Patients in Different Place of Service.

[KristenB]

We are a group practice that has a few Dr.'s, NP's and PA's in an outpatient mental health professional office setting.

If one of our PA's or NP's sees patients in a nursing home outside of the office setting for medication management (E/M) what CPT codes would be used and would there be modifiers needed?

In the office setting we would normally use the E/M codes, so would these still be used (99211-99215) with modifiers in the nursing home(assisted living facility)? Or should the nursing facility services codes be used? Which CPT codes should we be using?

 

[thomas7331]

For E/M services in a skilled nursing facility, you would use CPT codes 99304-99306 (for the initial visit during the patient's admission to that facility) or 99307-99310 (for subsequent visits). For assisted living facilities, the E/M codes are 99324-99328 (for new patients) or 99334-99337 (for established patients). There are no modifiers specifically required for use in these facilities, but your place of service code on the claim should reflect the type of facility where services were rendered.

 

[pudge2465@yahoo.com]

We have a new physician in our practice that sees patients in SNF. He is billing 99306 with 99358. I am not familiar enough with these codes and I keep get rejections.