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Nursing home admit

  1. #1
    Question Nursing home admit
    Medical Coding Books
    We had a patient to come into the office for a physical to be admitted to nursing home. Physician done the phy, filled out the 90L and he is also the admitting physician. Do we charge the CPT code for the nursing home admit example 99304, 99305, 99306 or do we charge an E/M visit. Please help the confusion. we are charging the 99306 he spent over 50 minutes with patient and family


  2. #2
    Milwaukee WI
    Default Is patient going direct to Nursing Home from Office?
    If the patient is actually being admitted to the nursing home the same date of service as the physician is seeing that patient in the office for the admit physical, then yes, you'd code from the 99304-06 series. If the nursing home admit is later then you should be coding appropriate level office visit.

    You mention the physician is spending 50 minutes with patient/family.
    You cannot code 99306 JUST because of the time spent. For coding based on time: 1) the physician states the total time; 2) physician states that 50% or more of the time was spent in counseling/coordination of care; AND 3) the substance of the counseling/coordination is documented. For example: "50 minutes spent w/ patient and family today; more than 50% of this time was spent in counseling and coordination regarding expected outcomes, availability of therapies/treatment, and answering questions of patient and family."

    If the physician met the bullet points for comprehensive history, comprehensive exam and high MDM then you can bill 99306 without time as a factor.

    F Tessa Bartels, CPC, CPC-E/M

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