I have a question regarding subsequent nursing facility visits. When auditing claims I am finding that most of these visits are coding out to a 99309. I checked in the CPT Manual it states for a 99309 "Usually, the patient has developed a significant complication or a significant new problem." Generally this is not the case, the patient is usually stable without a new complaints. The MDM is usually Moderate due to multiple chronic conditions that are stable and prescription drug management. The physician is generally billing a 99307.

I tried to do some research on this and I did find the following information in the book Practical E/M by Stephen Levinson, MD. "The CPT codebook provides four levels of subsequent nursing facility care. The distinguishing feature of this type of service is that the descriptor for the NPP relate to a patient's clinical status on the date of care and have wording similar to that used for subsequent inpatient care. (Nature of presenting Problem) stable - level 7, inadequate response - level 8, significant new problem - level 9.