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Skilled Nursing Facilities

  1. Default Skilled Nursing Facilities
    Medical Coding Books
    I am would like to know if a SNF is inpatient or outpatient and how to bill for that with accurate documention. I have several nephrologists that have been seeing patients at a SNF facility and we don't know if it is considered inpatient or outpatient. And where can I find that information.

  2. Default SNF billing
    I believe the professional services portion is billed as outpatient but you need to bill the nursing home for the technical portion. Check the CMS website for more info.

  3. Default
    it was not really specified if it is inpatient or outpatient

  4. #4
    Fort Worth Texas
    Are you wanting to bill an E&M service? There are specific E&M codes for Skilled Nursing Facilities. See 99304-99310.
    Last edited by MCook; 12-29-2012 at 05:10 AM. Reason: spelling correction
    Michelle Cook,CPC, CPCO, CPMA, CEMC, CGSC, CPEDC,
    2017 AAPC MACRA Proficient

  5. #5
    Columbia, MO
    Quote Originally Posted by massuez View Post
    I believe the professional services portion is billed as outpatient but you need to bill the nursing home for the technical portion. Check the CMS website for more info.
    SNF facilities are inpatient facilities they do not offer outpatient services. You do not bill professional services outpatient. However you may need to bill your professional services direct to the SNF facility. That is what the article is telling you.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Under Consolidated Billing, if a nursing home patient is in a skilled bed, then any lab services, IV antibiotics, etc., are billed to the nursing home and not to Medicare. Physician visits are still billed to Medicare Part B. The CMS article lists several examples of separately billable services - those can be billed to Medicare Part B. What's happening, basically, is nursing home patients who are put into "skilled bed" (or "swing bed") status become covered under Medicare as though they are hospital inpatients.

    As far as what CPT codes and POS to use for physician visits to a nursing home (I assume you mean nursing home and not skilled nursing in a hospital), we're just starting to do that at my office so we're trying to figure it out, too! It sounds like you should bill POS 32 if the patient is in a skilled bed and use CPT codes 99304 - 99310. If they are NOT in a skilled bed, use POS 32 and CPT codes 99324 - 99337 - ? (again, assuming you mean in a nursing home - ) The POS doesn't sound right, but Medicare has told us specifically to use POS 32 for skilled patients in a hospital SNU (we learned this by being RAC audited).-- Maybe POS 31 should be used for a nursing home - ?


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