Coding Cues: The difference between billing for skilled nursing facility vs. custodial care

June 6, 2008

We're about to take on nursing home patients and have the following billing questions: Is billing different for patients in a nursing home versus a skilled nursing home, and what's the difference between the two? Do we bill the nursing home or the insurer?

Key Points

We're about to take on nursing home patients and have the following billing questions: Is billing different for patients in a nursing home versus a skilled nursing home, and what's the difference between the two? Do we bill the nursing home or the insurer?

First, some definitions: A skilled nursing facility-now called a nursing facility-is one in which there's a medical component to the care patients receive. (In contrast, a domiciliary, or rest home facility, provides only custodial care.)

The codes used to report nursing facility services are 99304-99316; 99318 for the requisite annual assessment; and 99339-99340 for care plan oversight services, which can be charged for patients under the care of a home health agency or hospice. Domiciliary, rest home, or custodial care services are reported using codes 99324-99337.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.