Corporate

January 15, 2014 - Revised: 01.18.19

Reporting Federally Mandated Visits (CPT Codes 99307-99310)

CPT codes 99307-99310 (Subsequent Nursing Facility Care, per day) shall be used to report federally mandated physician visits and other medically necessary visits.

The initial visit in a skilled nursing facility (SNF) and nursing facility (CPT 99304-99306) must be furnished by a physician except as otherwise permitted as specified in the Code of Federal Regulations (42 CFR 483.40(c)(4)). Qualified Non-Physician Practitioners (NPPs) may provide federally mandated visits (after the initial visit by the physician and as permitted under the Long Term Care Regulations).

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.
  • These visits are considered timely if they occur no later than 10 days before or after the date the 30/60 day visit was required.

Report medically necessary E/M visits using CPT codes 99307-99310 even if they are provided prior to the initial visit by the physician.

Documentation should consist of the following:

If the primary reason for the physician/NPP visit is the performance of a Federally Mandated visit, the documentation should reflect the following:

  1. The Chief Complaint or rationale for the visit in the clinical note should reflect the visit that date was for a federally mandated or 30- or 60-day visit.
  2. The documentation must support a review of the resident's total program of care was performed. This must include:
    • A review of medications
    • A review of current treatment plan
    • Review of all patient diagnoses and current status of each.
  3. Write, sign, and date progress notes at each visit.
  4. The documentation and/or time listed in note should support the level of care billed.

The federally mandated E/M visit may serve also as a medically necessary E/M visit if the situation arises (i.e., the patient has health problems that need attention on the day of the scheduled mandated physician E/M visit.) When this occurs:

  1. The Chief Complaint or rationale for the visit indicate both the medical necessity for the visit as well as indicate this was a federally mandated visit.
  2. The documentation must support the level of care billed for medical necessity.
  3. The documentation must support all the criteria for a federally mandated visit:
    • A review of medications
    • A review of current treatment plan
    • Review of all patient diagnoses and current status of each.
  4. Write, sign, and date progress notes at each visit.
  5. The documentation and/or time listed in note should support the level of care billed.

An annual nursing facility assessment visit code may substitute as meeting one of the federally mandated physician visits if the code requirements for CPT code 99318 are fully met and in lieu of reporting a Subsequent Nursing Facility Care, per day, service (CPT codes 99307 – 99310). The CMS Medicare Claims Processing Manual (chapter 12, section 30.6.13.B) specifies that the annual nursing facility assessment visit "shall not be performed in addition to the required number of federally mandated physician visits."

Ohio Regulations regarding medical supervision:

  • Each resident of a nursing home shall be under the supervision of a physician.
  • Each resident of a nursing home shall be evaluated by a physician or other licensed health professional acting within the applicable scope of practice, at least once every thirty days for the first ninety days after admission or three evaluations.
  • After this period, each resident of a nursing home shall be evaluated by a physician or other licensed health professional acting within the applicable scope of practice at least every sixty days, except if the attending physician documents in the medical record why it is appropriate. The resident may be evaluated no less than once every 120 days.
  • The evaluations required by this rule shall be made in person. In conducting the evaluation, the physician or licensed health professional shall solicit resident input to the extent of the resident's capabilities.
  • The physician or licensed health professional shall write a progress note after each evaluation depicting the current condition of the resident based upon consideration of the physical, mental and emotional status of the resident.
  • A physician or licensed health professional visit is considered timely if it occurs no later than10 calendar days after the date the visit was required.

Kentucky Regulations regarding medical supervision:

  • The health care of each patient shall be under supervision of a physician who, based on an evaluation of the patient's immediate and long-term needs, prescribes a planned regimen of medical care which covers indicated medications, treatments, rehabilitative services, diet, special procedures recommended for the health and safety of the patient, activities, plans for continuing care and discharge.
  • Patients shall be evaluated by a physician at least once every 30 days for the first 90 days following admission. Subsequent to the 90th day following admission, the patient shall be evaluated by a physician every 60 days. There shall be evidence in the patient's medical record of the physician's visits to the patient at appropriate intervals.
  • There shall be evidence in the patient's medical record that the patient's attending physician has made arrangement for the medical care of the patient in the physician's absence.
  • The facility shall have arrangements with one (1) or more physicians who will be available to furnish necessary medical care in case of an emergency if the physician responsible for the care of the patient is not immediately available.

References:


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