Need clarification on 99305

JulieGrawe

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I am the billing supervisor for a thriving Geriatric practice that cares for patients in various nursing facilities. We have been using CPT code 99305 without any question since 2009 each time we have taken over care. We see each resident for an initial evaluation and management including history, physical and all required key components. Our providers were recently at a Directorship Conference & one of the speakers at the conference said that you could only bill 99305 if the pt. had been admitted or re-admitted to the facility within the last 30 days. I can't find anything in the section notes or guidelines of the CPT book that states this code is only billable within 30 days of an admission. In researching a bit, we found a CMS publication, transmittal 1875-section 30.6.13A, paragraph two, that does mention that the visit must occur no later than 30 days after admission but I read MULTIPLE other articles regarding this code and none of them mentioned this requirement. The initial visits are typically quite time consuming as these patients have both severe, acute conditions and complicated, challenging chronic conditions with extensive history to review. The reimbursement should reflect this. We are currently in
negotiations of acquiring another facility or two and are looking for some guidance to assure that we are billing correctly.
 
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