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Nursing home readmit

  1. #1
    Default Nursing home readmit
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    Not sure if anyone has any insight on this. CMS is kind of hard to understand. One of my doctors has been seeing a patient in a nursing home for CHF and COPD. She was recently hospitalized for 3 days due to anemia with chronic blood loss requiring blood transfusions. When she was discharged from the hospital, she was sent back to the nursing home. My physician wants to know if he can bill an initial nursing home visit (99306) or does he have to go to using the subsequent nursing home visit (99310) after she was discharged and sent back to the NH? He had to write up a new plan of care for her including the anemia due to chronic blood loss, not sure if that matters though. It sounds like CMS is saying "30 days" but it isn't real clear on nursing home -> hospital -> nursing home billing. It seems like it was more for hospital -> nursing home -> hospital readmission.

    Is there anyone that can clarify this for me?

    Many thanks for any assistance!

  2. #2
    Default Any response?
    I know this post is from a while back, but it is the exact question that I had. Did you ever get any response? What did you figure out?

    I have a provider who was told they could charge an Initial NH code again, even if they had been the primary provider during the previous NH stay. Personally I don't think that is right since the patient is essentially established.

    Your thoughts would be appreciated.
    Cory Bauer
    Rochester, MN

  3. #3
    Seacoast- Dover New Hampshire
    I too am having the same issue. Pt has been in Nursing home for along time. Became ill with heart issues, got admitted IP. was stabilized and d/c. by Hospitalist. MD of nursing home wants to do readmit 99306?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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