Coding Consult

March 3, 2006

Nursing facility codes

New 2006 nursing facility coding now mirrors coding for inpatient hospital services-and it allows you to capture care for highly complex patients.

Another change: Now you will no longer have to make a distinction between comprehensive NF assessments (99301-99303) and subsequent NF care (99311-99313). CPT 2006 deletes these code families and replaces them with the codes we describe below. The discharge codes (99315-99316), however, weren't changed.

When you admit or readmit a patient, you'll choose one of the new "Initial Nursing Facility Care" codes based on key components of history, examination, and medical decision-making. The new assessment codes describe three levels of care and are consistent with the codes for initial hospital care. Like with the hospital care codes , it doesn't matter if the patient is new or established.

Here's how the new E&M codes define the key components of history, exam, and medical decision-making. (The time component has been excluded in the new codes.)

Coding subsequent care

CPT 2006's new codes for subsequent nursing facility care (99307-99310) allow you to bill for a more extensive E&M service than previously possible. The old "Subsequent Nursing Facility Care" subsection (99311-99313) contained only three levels of service. And the highest level was a detailed interval history and a detailed examination.

So when a nursing facility patient required comprehensive subsequent care without a new facility-required comprehensive assessment, the old codes didn't permit you to accurately capture the situation. "This sometimes led to misuse of 99302 [the old code for comprehensive NF assessment for a patient with a significant change in condition requiring a new care plan]," says geriatrician Peter A. Hollmann, a member of the AMA's CPT Editorial Panel.

CPT 2006 creates a new fourth level of service code (99310) for reporting a comprehensive level of service. Hollmann doesn't expect 99310 to be "a high-volume code, but it will allow physicians to code a broader range of services," including the following scenarios:

Example 1: You perform a comprehensive history, comprehensive exam, and high medical decision-making for a nursing facility patient who developed pneumonia and dehydration. "Although the acute illness represents a very significant change in the patient's condition, because it isn't permanent in nature, the old code 99302 (assessment involving a major permanent change of status) is inappropriate," says Hollmann. Now you should report 99310 for this service.

Example 2: An NF patient's family is unhappy with a previous physician and asks you to assume the individual's care. At the initial patient encounter, you perform a comprehensive history, comprehensive exam, and moderate medical decision-making.

"Because the care doesn't involve an admission or readmission, the old 99303 code doesn't describe the situation," Hollmann says. Now 99310 will represent this service.

The new subsequent nursing facility care codes in a nutshell: The old code descriptors have basically been carried over to the new codes, but new levels exist which require two of the three key components described below:

These new codes, like the admission codes, don't contain typical time units.

Coding an annual assessment

There's a new subsection ("Other Nursing Facility Services") to code a comprehensive annual assessment.

When you perform an annual assessment, you should report 99318 (evaluation and management of a patient involving an annual nursing facility assessment) instead of the old 99301. New code 99318 is virtually identical to 99301 but with slightly higher medical decision-making. The medical decision requirement changes from "straightforward/low" to "low to moderate," and the new code doesn't contain a time allotment.

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit