• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

modifier for E&M w/SNF resident?

Karen A.

Grants Pass
Best answers
We have a medicare pt, we did not know she was in skilled nursing facility in a covered part A stay. This patient was brought to our "professional office/non facility". We saw her for 2 E&M visits and an endometrial biopsy. We billed medicare part B, they paid & have recouped the payment. I have been unable to find any information on billing office visits/procedures in such a way that medicare will cover them when done in our office. Do we bill the SNF directly without billing medicare? Any advice will be greatly appreicated. This is a very rare occurance for our OB/GYN group.


Best answers
if you go onto cms's website there is a listing for snf consolidated billing which shows which codes medicare will pay and what needs to be sent to snf. for the codes that are not covered by medicare you do bill snf directly. e/m codes are generally covered by medicare so i'm not sure why the recouped payment on those.