Nursing homes are becoming more popular with the aging population. In 2020, the U.S. Centers for Disease Control and Prevention (CDC) reported that around 1.3 million people were enrolled in over 15,000 certified nursing homes. Now, there are over 25,000 nursing homes in the US.
These centers provide skilled nursing, rehabilitation, and other services to older people. However, like any other medical institution, nursing homes also need revenue to operate effectively. Many insurance companies, including Medicare and Medicaid, cover these services. But they require accurate coding. Therefore, we bring some of the most commonly used nursing home CPT codes to your screens. But first, let’s explore nursing home services.
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Nursing Homes Explained
Before coding any process, you should be familiar with all the services provided by nursing home services. For clarification, nursing homes are long-term care facilities for senior citizens. These people usually have a medical condition that impacts their ability to live independently. Most people confuse nursing homes with skilled nursing facilities. However, they are quite different.
Skilled nursing facilities (SNFs) provide short-term support to patients recovering from serious injuries or medical conditions. In simple words, they help patients in transitioning out of hospitals. On the other hand, nursing homes assist with daily activities, including meals, dressing, and hygiene.
As you can see, nursing homes and SNFs offer different levels of care and durations of stay. However, they overlap because most assisted living facilities provide skilled nursing services to long-term patients requiring extra medical attention.
Common Nursing Home CPT Codes in 2024
The demand for long-term care services has increased. However, many nursing homes struggle financially due to their inability to keep up with the billing requirements, including accurate coding. We understand how difficult it is to secure payments from insurance companies these days.
However, you can avoid claim denials by using appropriate nursing home CPT codes to capture the provided services. Unlike other specialties, there are only a few CPT codes for nursing facilities. The AMA categorizes them into three groups, all related to evaluation and management services.
CPT Codes for Initial Nursing Home Visits
CPT Code 99304 – Initial Visit (25 minutes)
This nursing home CPT code addresses an evaluation and management service of a new or established patient. Healthcare providers use code 99304 to bill a 25-minute initial patient visit at a nursing care facility. Doctors use this visit to make basic medical decisions after assessing the patient.
CPT Code 99305 – Initial Visit (35 minutes)
This CPT code for nursing homes also falls within the range of preliminary care. Billing specialists use the 99305 code to claim reimbursements for a 35-minute initial health assessment. Nursing home specialists use this checkup to make intermediate medical decisions, such as multiple diagnoses and care planning.
CPT Code 99306 – Initial Visit (50 minutes)
This nursing home CPT code covers an extensive initial evaluation. Healthcare providers use CPT code 99306 to specify a 50-minute preliminary assessment and management service. They use this appointment to make advanced medical decisions, such as managing critical conditions and high-risk medications.
Nursing Home CPT Codes for Subsequent Care
CPT Code 99307 – Follow-Up Visit (10 minutes)
This CPT code falls within the range of subsequent nursing facility care. Nursing home specialists utilize the 99307 code to notify a payer about their 10-minute follow-up appointment with a patient involving evaluation and management. They use this visit to make simple decisions.
CPT Code 99308 – Follow-Up Visit (20 minutes)
The next popular nursing home CPT code for subsequent care in a nursing home is 99308. Billing specialists apply this code to bill a more detailed follow-up evaluation. This visit usually lasts up to at least 20 minutes, and healthcare providers use it to make standard care decisions.
CPT Code 99309 – Follow-Up Visit (30 minutes)
CPT code 99309 covers a 30-minute follow-up appointment at a nursing facility. Healthcare providers use this visit to monitor a patient’s progress since the last visit, identify new symptoms, and discuss further care strategies. In short, they use this appointment for moderate-risk assessments.
CPT Code 99310 – Follow-Up Visit (45 minutes)
This nursing home CPT code highlights a comprehensive follow-up evaluation and management appointment. Healthcare providers at nursing facilities use the 99310 CPT code to report that they have conducted a thorough subsequent assessment of a patient to monitor their progress.
During this visit, doctors spend at least 45 minutes with nursing home residents to address their evolving conditions and requirements.
Nursing Home CPT Codes for Discharge Services
CPT Code 99315 – Final Visit (Discharge Management up to 30 mins.)
This nursing home CPT code addresses a final care assessment. Billing specialists use the 99315 CPT code to inform a payer that a healthcare provider has spent less than 30 minutes managing a patient’s departure from a nursing facility.
This appointment usually involves tasks such as finalizing paperwork and discussing follow-up care. In short, long-term specialists use these discharge visits to make sure that the transition process of a former nursing home resident to the next care setting or home is smooth.
CPT Code 99316 – Final Visit (Discharge Management over 30 mins.)
This CPT code for nursing homes indicates an all-inclusive final appointment at a nursing facility. Skilled nursing experts use the 99316 CPT code to bill a discharge management service of more than 30 minutes.
They use this meeting to perform a final health assessment of a patient and discuss financial matters. Moreover, long-term caregivers make sure that all the necessary documentation is completed for a smooth departure.
Bottom Line
There you have it! The CPT codes for nursing homes are quite limited compared to other specialties, which simplifies the coding process. However, annual updates are a problem, especially if you are already overburdened with your primary operations and don’t have the time to file or resolve claims.
Outsourcing is a cost-effective solution. You can always partner with a reliable name like MediBillMD to streamline your financial operations. Our nursing home billing services effectively manage your revenue cycle and guarantee excellent outcomes.
