tscobee
Networker
If we have a Part B provider who see patients and a skilled nursing facility, do we use CPT codes 99218-99223 or 99231-99233?
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Wiki Skilled Nursing Facility
- Thread starter tscobee
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thomas7331
Guest
No, those are codes for patients in hospitals. For skilled nursing patients you'd use codes in the 99304-99318 range.
tscobee
Networker
Thank you!
lgardner
Guest
I was recently asked this by a provider and here was my response to him:
I just found this response from CMS; this was posted in July, but it looks like they understand your concerns, but are planning to accept this change in codes.
Please, see below for more information about this (emphasis added by me):
We are proposing to accept CPT's deletion of CPT code 99318. Our longstanding manual guidance states that an annual nursing facility assessment visit code may substitute as meeting one of the required physician visits, as specified in 42 CFR 483.30 (c)(1), if the code requirements for CPT code 99318 are fully met (Medicare Claims Processing Manual (Pub. 100-04) chapter 12, section 30.6.13 (B)). Due to the longstanding nature of the manual section, we believe some provisions may be outdated, and it is possible to satisfy this requirement through other codes. We are seeking comment on whether there is a need to keep this code for Medicare purposes. As we consider accepting the CPT's deletion of CPT code 99318, we are concerned that the absence of a similar code could cause an unwarranted increase in valuation of other services under the PFS, and CMS would not have a means of tracking how often these visits are occurring. While CPT code 99308, CPT code 99309, and CPT code 99310 could be used to report the required annual visit, if we were to accept deletion of CPT code 99318, we believe most of the utilization for that former code would instead be reported under CPT code 99309, with a RUC-recommended work RVU of 1.92 which is described in the valuation section below.
b. Valuation
After considering the utilization and the need for the service described by CPT code 99318, we are proposing to accept the CPT's deletion of CPT code 99318. Given the proposed deletion for CPT code 99318, the RUC recommends that 10 percent of the CPT code 99318 utilization would go to CPT code 99308, with a work RVU of 1.16; 85 percent of the utilization would go to CPT code 99309, with a work RVU of 1.55; and 5 percent of the utilization would go to CPT code 99310, with a work RVU of 2.35.
Follow-up email:
I did find a later version, which stated the same thing, with this addition:
Comment: All commenters supported the CPT Editorial Panel decision to delete CPT code 99318, and stated that the service is reported sufficiently with other codes.
Response: We appreciate the feedback from the commenters regarding our proposal to accept the CPT Editorial Panel decision to delete CPT code 99318 and are finalizing as proposed to accept the CPT's deletion of CPT code 99318. We are also finalizing our proposal to accept the RUC-recommended utilization estimates for visits that would have been reported under this code.
I just found this response from CMS; this was posted in July, but it looks like they understand your concerns, but are planning to accept this change in codes.
Please, see below for more information about this (emphasis added by me):
We are proposing to accept CPT's deletion of CPT code 99318. Our longstanding manual guidance states that an annual nursing facility assessment visit code may substitute as meeting one of the required physician visits, as specified in 42 CFR 483.30 (c)(1), if the code requirements for CPT code 99318 are fully met (Medicare Claims Processing Manual (Pub. 100-04) chapter 12, section 30.6.13 (B)). Due to the longstanding nature of the manual section, we believe some provisions may be outdated, and it is possible to satisfy this requirement through other codes. We are seeking comment on whether there is a need to keep this code for Medicare purposes. As we consider accepting the CPT's deletion of CPT code 99318, we are concerned that the absence of a similar code could cause an unwarranted increase in valuation of other services under the PFS, and CMS would not have a means of tracking how often these visits are occurring. While CPT code 99308, CPT code 99309, and CPT code 99310 could be used to report the required annual visit, if we were to accept deletion of CPT code 99318, we believe most of the utilization for that former code would instead be reported under CPT code 99309, with a RUC-recommended work RVU of 1.92 which is described in the valuation section below.
b. Valuation
After considering the utilization and the need for the service described by CPT code 99318, we are proposing to accept the CPT's deletion of CPT code 99318. Given the proposed deletion for CPT code 99318, the RUC recommends that 10 percent of the CPT code 99318 utilization would go to CPT code 99308, with a work RVU of 1.16; 85 percent of the utilization would go to CPT code 99309, with a work RVU of 1.55; and 5 percent of the utilization would go to CPT code 99310, with a work RVU of 2.35.
Follow-up email:
I did find a later version, which stated the same thing, with this addition:
Comment: All commenters supported the CPT Editorial Panel decision to delete CPT code 99318, and stated that the service is reported sufficiently with other codes.
Response: We appreciate the feedback from the commenters regarding our proposal to accept the CPT Editorial Panel decision to delete CPT code 99318 and are finalizing as proposed to accept the CPT's deletion of CPT code 99318. We are also finalizing our proposal to accept the RUC-recommended utilization estimates for visits that would have been reported under this code.
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HI! How frequent can cpt 99308 be used? daily or once every 120 days ? Thank you!