Q&A: Coding for work in extended-care facilities

Billing for services in nursing facilities depends on extent of care.


I am frequently asked by primary care physicians to consult patients in extended care facilities and rehabilitation nursing facilities. Which codes should I use to report consultations in these locations?

According to CPT, "In the hospital or in nursing facility settings, the consulting physician should use the appropriate inpatient consultation code (9925199255) for the initial encounter, then subsequent hospital (9923199233) or nursing facility care codes if the consultant assumes management of a portion or all of the patient's condition(s)." These facilities typically include a medical component in their services and are designated with place of service 31 (skilled nursing facility) or 32 (nursing facility). In a domiciliary or custodial care facility, designated with place of service 33 (custodial care facility), outpatient consultation codes should be used (9924199245) for the initial encounter, then Established Patient Domiciliary, Rest Home (e.g., boarding home), or Custodial Care Services codes (99334-99337) for subsequent visits.

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