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

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.