e m codes nursing home visits

Coding for E/M home visits changed this year. Here’s what you need to know

CPT has revised codes for at-home evaluation and management (E/M) services as of Jan. 1, 2023. Services to patients in a private residence (e.g., house or apartment) or temporary lodgings (e.g., hotel or shelter) are now combined with services in facilities where only minimal health care is provided (e.g., independent or assisted living) in these code families:

Home or residence E/M services, new patient

• 99341, straightforward medical decision making (MDM) or at least 15 minutes total time,

• 99342, low level MDM or at least 30 minutes total time,

• 99344 (code 99343 has been deleted), moderate level MDM or at least 60 minutes total time, 

• 99345, high level MDM or at least 75 minutes total time.

Home or residence services, established patient   

• 99347, straightforward MDM or at least 20 minutes total time,

• 99348, low level MDM or at least 30 minutes total time,

• 99349, moderate level MDM or at least 40 minutes total time,

• 99350, high level MDM or at least 60 minutes total time. 

Select these codes based on either your level of medical decision making or total time on the date of the encounter , similar to selecting codes for office visits . The E/M codes specific to domiciliary, rest home (e.g., boarding home), or custodial care (99324-99238, 99334-99337, 99339, and 99340) have been deleted, and the above codes should also be used in those settings.

When total time on the date of the encounter exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. The exception to this is for patients with Medicare. For those patients, report prolonged home or residence services to Medicare with code G0318 in addition to 99345 (requires total time ≥140 minutes) or 99350 (requires total time ≥110 minutes). Code G0318 is not limited to time on the date of the encounter, but includes any work within three days prior to the service or within seven days after.

Services provided in facilities where significant medical or psychiatric care is available (e.g., nursing facility, intermediate care facility for persons with intellectual disabilities, or psychiatric residential treatment facility) are reported with codes 99304-99310 .

— Cindy Hughes, CPC, CFPC

Posted on Jan. 19, 2023

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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use .

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Coding Physician Visits in Skilled Nursing Facilities/Nursing Facilities

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As of April 22, due to the COVID-19 public health emergency , CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options. Prior to this, telehealth was only available for established patient visits.

Coding for Skilled Nursing Facility

• To be reported when the MD, DO, OD visits the patient in the Skilled Nursing Facility.
• Place of Service is 13.
• Initial Visit whether patient is new or established 99304, 99305, 99306
• Subsequent Skilled Nursing Facility visits performed in person or via telehealth: 99307, 99308, 99309, 99310

Coding for Nursing Home Visits

• To be reported when the MD, DO, OD visits the patient in a Nursing Home.
• Place of service is 13
• New Patient: 99324, 99325, 99326, 99327, 99328
• Established Patient: 99334, 99335, 99336, 99337
• Modifier -25

Note: When billing an intravitreal injection (or any minor surgery) the same day as an encounter, consider the definition of modifier -25 and although medically necessary, if the established patient exam is performed solely to confirm the need for the injection, the exam is not separately billable.

Coding for Home Visits

• To be reported when the MD, DO, OD visits the patient at their home.
• Place of service is 12
• New Patient: 99341, 99342, 99343, 99344, 99345
• Established Patient: 99347, 99348, 99349, 99350

View updates on telemedicine coding to use in your practice based on guidelines from CMS.

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The 2023 Hospital and Nursing Home E/M Visit Coding Changes

A step-by-step approach that saves time coding E/M office visits can now be tailored to hospital and nursing home E/M visits as well. Following the major revisions to coding evaluation and management (E/M) office visits in 2021, a similar revamp has been made for coding E/M visits in other settings. Effective Jan. 1, 2023, the history and physical examination requirements have been eliminated for coding hospital and nursing home visits. As with office visits, hospital and nursing home coding is now based solely on medical decision making (MDM) or total time (except for emergency department visits, which must be coded based on MDM, and hospital discharge visits, which must be coded based on time). This further streamlines E/M coding, creating one unified set of rules for office, nursing home, and hospital visits. Hospital and nursing home E/M visits are divided into three groups: initial services (i.e., admissions), subsequent services, and discharge services.

Medigy Insights

A step-by-step approach that saves time coding E/M office visits can now be used for hospital and nursing home E/M visits. Recent revisions to coding evaluation and management (E/M) visits have eliminated history and physical examination requirements for hospital and nursing home visits, making coding based solely on medical decision making (MDM) or total time. This change creates one unified set of rules for E/M coding across all settings, streamlining the process for initial, subsequent, and discharge services. Effective Jan. 1, 2023.

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How E&M Code Changes in 2023 Will Impact Nursing Facility Services

• By Colleen (Deighan) Ejak, RHIA, CCS, CCDS-O
• October 3, 2022

This category of E&M services will have three subcategories instead of the current four.

EDITOR’S NOTE:  The American Medical Association (AMA) announced major revisions to Evaluation and Management (E&M) Services for Jan 1, 2023. The E&M categories that will undergo revision in 2023 include inpatient and observation care services, emergency department services, consultations, nursing facility services, home and residence services, and prolonged services.

For 2023, revisions to the E&M category for nursing facility services include a deleted code, revised codes, and broad guidelines revisions. In 2023, this category of E&M services will have three subcategories instead of the current four: Initial nursing facility care, subsequent nursing facility care and nursing facility discharge services. The nursing facility annual assessment code, 99318, is deleted with parenthetical reference to report this service with the subsequent nursing facility care codes, 99307-99310. 

The subsection guidelines now indicate that these services are reported for E&M services to patients in nursing facilities and skilled nursing facilities. These codes should also be used to report evaluation and management services provided to a patient in a psychiatric residential treatment center and immediate care facility for individuals with intellectual disabilities.

Regulations pertaining to the care of nursing facility residents govern the nature and minimum frequency of assessments and visits. These regulations also govern who may perform the initial comprehensive visit.

Revisions to the remaining E&M categories, including Nursing Facilities Services, align the 2023 E&M codes with the 2021 revisions made to the office and other outpatient services codes. The three key components, history, exam, and medical decision making are no longer required for reporting these services. A medical appropriate history or physical as determined by the physician or APP should be documented; the level of service is determined solely be the level of medical decision making (MDM) or time. The AMA redefined what “time” includes for selection of the level of service, time is now the total time on the date of the encounter and includes both face-to-face time and non-face-to-face time.  Activities included in total time are the following:

• Preparing to see the patient
• Obtaining/reviewing separately obtained history
• Performing examination
• Counseling and educating the patient/family
• Ordering medications, tests, or procedures
• Referring and communicating with other health care professionals
• Documenting in the electronic health or other health record
• Independently interpreting results and communicating results to patient/family
• Care coordination (when not reported separately)

The revised guidelines state a high-level MDM-type specific to initial nursing facility care by the principal physician or other qualified health care professional is defined as multiple morbidities requiring intensive management. Moreover, it is also defined as a set of conditions, syndromes, or functional impairments that are likely to require frequent medication changes or other treatment changes and/or re-evaluations.

The patient is at significant risk of worsening medical (including behavioral) status and risk for (re)admission to a hospital. The principal physician is the physician who oversees the patient’s care as opposed to other physicians or qualified health care professionals who may be furnishing specialty care.

Initial nursing facility care codes 99304, 99305, 99306 may be used once per admission, per physician or other qualified health care professional, regardless of length of stay. They may be used for the initial comprehensive visit performed by the principal physician or other qualified health care professional. Skilled nursing facility initial comprehensive visits must be performed by a physician. Qualified health care professionals may report initial comprehensive nursing facility visits for nursing facility level of care patients, if allowed by state law or regulation. An initial service may be reported when the patient has not received any face-to-face professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice during the stay.

I have shared the code revisions for nursing facility services and a few of the key guideline revisions. If your providers see patients in nursing facilities a complete review and understanding of the coding and reporting guidelines is essential to proper payment. Coding professionals should be aware of these revisions because they will affect reimbursement. Consider reviewing current documentation practices and revise documentation templates not needed for patient care. Also consider how your providers can track total time in to correctly report and bill for these services.

Programming note: Listen to Colleen Deighan’s live reporting on E&M updates today during Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer at 10 Eastern.

References :

American Medical Association 2023 E&M Code and Guideline changes, available at: 2023 CPT E&M descriptors and guidelines (ama-assn.org)

Billing and Coding: Evaluation and Management Services in a Nursing Facility, available at https://www.cms.gov/medicare-coverage-database

AMA CPT® Professional 2022 Codebook © 2021 American Medical Association

AMA CPT® Assistant, August 2022, Pg 3,  E&M Revisions for 2023: An Overview

• TAGS: AMA , Coding , E&M , Inpatient , Observation , Skilled Nursing Facilities (SNF)

Colleen (Deighan) Ejak, RHIA, CCS, CCDS-O

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The 2023 Hospital and Nursing Home E/M Visit Coding Changes

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https://www.barrons.com/news/nine-die-in-care-home-fire-outside-moscow-01589180405

• FROM AFP NEWS

Nine Die In Care Home Fire Outside Moscow

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The fire is the second such incident around Moscow in just over a month

A fire broke out in a retirement home in the Moscow region, killing at least nine people, local authorities said Monday.

The blaze in the privately-owned care home in the town of Krasnogorsk started at around midnight Sunday and was extinguished within an hour, emergencies services said.

"Nine people died on site and nine more were rushed to hospital in serious condition and are being treated in intensive care," the Krasnogorsk municipal government said in a statement.

Russian news agencies said 37 people were in the building at the time of the fire.

Investigators said the victims whose burnt bodies were recovered were aged between 66 and 90.

They said a faulty electrical wire was a possible cause of the incident and launched a probe into fire safety violations.

They later detained the care home's manager, treating him as a suspect, news agencies reported.

Kommersant newspaper said many of the care home residents were not mobile and the employees were unable to carry them out despite the fire being small.

The blaze is the second such incident around Moscow in just over a month: investigators are probing another fire in an upscale retirement home in Moscow in April, which caused the deaths of six people.

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