Wiki Medicare Consult for Skilled Unit

[cbeuerlein]

I work in an orthopedic clinic. One of our doctors was consulted to see a patient in a skilled unit. Do I bill initial or subsequent nursing facility care? We were not the admitting. Also, any reference material regarding this would be great.

Thanks
Carrie

 

[Mojo]

Hi Carrie:

Per Medicare Learning Network (MLN) MM6740:

In the inpatient hospital setting and nursing facility setting, any physicians and
qualified NPPs who perform an initial evaluation may bill an initial hospital care
visit code (CPT code 99221 – 99223) or nursing facility care visit code (CPT
99304 – 99306), where appropriate.

Highmark Medicare Services mentioned during an Inpatient E/M teleconference that if physicians other than the admitting physician do not meet the 3 out of 3 components of an initial visit, a subsequent visit can be coded with supporting documentation. This Medicare decision may have caused some confusion.