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E/M code for Assisted Living Place

  1. #1
    Default E/M code for Assisted Living Place
    Exam Training Packages
    Hello All,

    One of our Doctor goes to an assisted living place and see patients there. There is a room there that is like a doctor office and that has a waiting room. He does not going to the patient's individual apartments.
    I am confusing with the below options.
    1. Does this get coded as a regular office visit.
    2. Does it get coded as Domiciliary Rest Home Custodial service.

    Also which Place of Service should be used.
    - Office visit with 11 or 13 or 14
    - Domiciliary Rest Home Custodial service with POS 13 or 14 or 33.

    All your answers are appriciated.

  2. #2
    Dover Seacoast New Hampshire
    It doesn't matter if he's seeing the patient in the bathroom at the assisted living facility....that's the place of service. Use POS code 33...custodial care. Make sure that this is a true assisted living facility...with no medical component. Otherwise, your patient is in a nursing facility.

    Use codes from the 99324-99327 section of E&M for assisted living facility services provided by a physician.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3
    Thanks for your reply,

    My Doctor provides medical care to the patients, like prescribing medicines in office like room in the assisted living place.

    Last edited by sam_son ; 06-16-2011 at 09:56 AM.

  4. #4
    Dover Seacoast New Hampshire
    That's not what I meant. Does the facility provide medical care? That's one thing that detemines the difference between nursing facility and assisted living facility.

    Don't get the two confused, because you'll bill in error to Medicare. A fate worse than death!

    Have a good weekend.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  5. Default Audit Tool
    Does anyone know of an audit tool for ALF EM codes?

  6. Default
    Assisted Living Centers: Will Medicare pay if they have no NPI number?

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