Corporate

March 14, 2013 - Revised: 01.18.19

Subsequent Nursing Facility Care (CPT Codes 99307-99310): Claim Submission and Documentation

Medicare will pay for federally mandated visits that monitor and evaluate residents at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. Submit CPT codes 99307-99310 (Subsequent Nursing Facility Care, per day) in the following circumstances:

  • Federally mandated physician visits and other medically necessary visits
  • Medically necessary Evaluation & Management (E/M)services, even if they are provided prior to the initial visit by the physician
  • Medically complex care in a Skilled Nursing Facility (SNF) upon discharge from an acute care visit, even if the visits are provided prior to the physician's initial visit

Submitting claims for visits in SNFs and nursing facilities (NFs):

  • Consultation codes may not be submitted on Medicare claims.
  • Submit the most appropriate visit code that represents the service provided.
  • In all cases, documentation in the patient's medical record must support the medical necessity for services submitted (including the level of E/M service).
  • Submit claims for the first E/M service for a Medicare beneficiary in a SNF or NF during the patient's facility stay, even if that service is provided prior to the federally mandated visit, with the most appropriate E/M code that reflects the services the practitioner furnished. This includes:
    • Initial nursing facility care codes (CPT codes 99304-99306)
    • Subsequent nursing facility care code (CPT codes 99307-99310), when documentation and medical necessity do not meet the requirements for submitting an initial nursing facility care code

Medical Necessity, Level of Service, Time, and Signatures

Medicare allows only the medically necessary portion of the visit. Even if a complete note is generated, only the necessary services for the condition of the patient at the time of the visit can be considered to determine the level of the E/M code.

  • Check your documentation: is the level of service supported?
    • CPT code 99307 requires at least 2 of these 3 components: problem focused interval history, problem focused exam, straightforward medical decision making
    • CPT code 99308 requires at least 2 of these 3 key components: expanded problem focused interval history, problem focused exam, medical decision making of low complexity
    • CPT code 99309 requires at least 2 of these 3 components: detailed interval history, detailed exam, medical decision making of moderate complexity
    • CPT code 99310 requires at least 2 of these 3 components: comprehensive interval history, comprehensive exam, high complexity medical decision-making
  • If you are selecting the CPT code for an E/M service based on time, document the time spent on counseling and/or coordination of care in the patient's medical record. In order to select an E/M code based on time, the visit must consist predominantly of counseling and/or coordination of care.
  • All documentation must be signed by the person providing the service.

Reference:


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