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Thread: Medicare Consult for Skilled Unit

  1. #1

    Default Medicare Consult for Skilled Unit

    AAPC: Back to School
    I work in an orthopedic clinic. One of our doctors was consulted to see a patient in a skilled unit. Do I bill initial or subsequent nursing facility care? We were not the admitting. Also, any reference material regarding this would be great.


  2. #2


    Hi Carrie:

    Per Medicare Learning Network (MLN) MM6740:

    In the inpatient hospital setting and nursing facility setting, any physicians and
    qualified NPPs who perform an initial evaluation may bill an initial hospital care
    visit code (CPT code 99221 – 99223) or nursing facility care visit code (CPT
    99304 – 99306), where appropriate.

    Highmark Medicare Services mentioned during an Inpatient E/M teleconference that if physicians other than the admitting physician do not meet the 3 out of 3 components of an initial visit, a subsequent visit can be coded with supporting documentation. This Medicare decision may have caused some confusion.

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