Wiki SNF visits

[Rpollock623]

I have an optometrist who is thinking about doing eye exams at a local Nursing Facility. I have looked in the Medicare SNF billing and Consolidated billing requirements, and hate to say but I am even more confused with how to get this started. Can someone tell me what codes are best to use and what are the requirements, any modifier's?

Thank you so much in advance for any help you can give me.

 

[SRCoding]

SNF Visits

Hi Rebecca,

We have an Optometrist that visits nursing homes, these visits are typically medical driven and are requested by the NH doctor. We use the NH E/M codes, 99307-99309 (Subsequent Nursing Facility care). This does not require billing any modifiers unless the patient is enrolled in Hospice, then you need to report a GW modifier if the reason for the visit is unrelated to the hospice care/condition. You do need to indicate your place of service (32- Nursing Home) and the facility name.

I was at a seminar recently where I heard some talking about specialists using the Initial Nursing Facility codes as well as the Subsequents and the criteria was that it had to be the first visit within each period of stay meaning if the patient is released and then re-admitted later on you can bill another initial visit as long as its the first time you saw them during that stay. That's something I need to look into because in the past I was told specialists could only use the subsequent codes as the admitting doctor would be billing the Initial E/M... now I have reason to think otherwise, maybe someone else on here can confirm that part for us.

Hope this helps.

Stephanie K, CPC