With over 1.2 million residents, nursing facilities have a sizable workforce in the U.S. However, billing is a major challenge due to the unique coding method. Coding for nursing facility care is divided into three parts: initial, subsequent, and discharge services.
Each part includes several visits with varying complexities represented by different codes. Hence, even professional coders often under- or over-code these services. Searching for an accurate code to document an expanded problem-focused evaluation and management (E/M) visit in a nursing facility? You can use CPT code 99308.
To code with confidence, read on to understand its key components and accurate usage guidelines.
CPT Code 99308 – Description
As indicated in the intro, 99308 is one of the subsequent visit codes for nursing facility care. In simple terms, it helps you bill for the ongoing, medically necessary E/M services you provide to the residents in nursing facilities. But what exactly does this code cover?
CPT code 99308 specifies a subsequent nursing facility care visit per day for patients with moderate complexity health conditions. It lasts at least 20 minutes and involves two of the following components:
- An expanded problem-focused interval history
- An expanded problem-focused examination
- Low-level decision-making
Scenarios Where CPT Code 99308 is Applicable
So, when is this code applicable? Let’s look at the following scenarios to understand its usage.
Minor Adjustment in Diabetic Foot Ulcer Care
Around 83.1% of residents in a nursing facility are 65 years of age or older. A common risk with increasing age? Developing chronic health issues, such as diabetes. So, for our first scenario, suppose a 72-year-old resident with type 2 diabetes has a minor ulcer in his left foot.
Despite the treatment, the abscess continues to emit a foul odor. Hence, after analyzing the current medications, the nursing facility physician evaluates the ulcer, reviews the patient’s blood glucose history, and makes minor adjustments in the treatment plan. He then reports this 20-minute-long subsequent visit with CPT code 99308.
Postoperative Hip Replacement Care
Hip fractures are one of the leading causes of disability in the United States. Did you know that around 300,000 people (mostly women) suffer from these injuries every year in the U.S.? For this scenario, consider a 75-year-old woman residing in a skilled nursing facility (SNF) for 2 months.
She is on postoperative recovery following a hip replacement surgery. Due to decreased mobility, she reports joint stiffness and minor swelling. During one of the subsequent visits, the healthcare provider spends at least 20 minutes evaluating her condition and conducting a physical exam.
Ultimately, he adds some gentle exercises in her treatment plan and then reports this low-level decision-making visit with CPT code 99308.
Post-Pneumonia Hospitalization Follow-Up
It is recommended for seniors to seek short-term rehabilitative care post-pneumonia hospitalization. Therefore, let’s assume an 81-year-old man in a similar scenario. During his stay in an SNF, he complains about experiencing mild shortness of breath with exertion.
Hence, the physician evaluates his new symptoms and reviews his oxygen level. This visit lasts for at least 22 minutes. Since the patient’s condition is not severe, the healthcare provider recommends some breathing exercises and an inhaler. He then bills for this subsequent visit using CPT code 99308.
Applicable Modifiers for CPT Code 99308
The most common applicable modifier with CPT code 99308 is modifier 25.
Modifier 25
Was the follow-up nursing facility visit distinct from other services you provided to the same patient on the same day? For example, you performed wound debridement and then evaluated the patient’s new symptoms after a recent pneumonia hospitalization. In this case, you should append modifier 25 to CPT code 99308.
CPT Code 99308 – Billing & Reimbursement Guidelines
Don’t have time to look up the specific billing rules for CPT code 99308? We have done the work in your stead! Simply follow these tips when using this code:
Use 99308 Only for Subsequent Nursing Facility Care Visits
You should be aware by now that the 99308 CPT code is only applicable for a subsequent visit. It means you can only use it to bill for a follow-up visit in a nursing facility. Remember, the setting is important because there are other E/M codes for hospital care encounters.
In short, you cannot use this code in hospital settings or for initial evaluation and management.
Bill One 20-Minute Visit Per Day
This is another important reminder! CPT code 99308 covers only one subsequent visit of at least 20 minutes per day. Hence, avoid using it to bill for multiple nursing facility care encounters within the same day.
Meet the Documentation Requirements
Besides duration, the only way to justify this code’s selection is through documentation. You must include the following details in the patient’s record:
- Expanded problem-focused history (chief complaint, HPI, PFSH)
- Expanded problem-focused exam
- Medical decision-making of low complexity, which requires meeting 2 of the following 3 criteria:
- Limited management options
- Limited data to be reviewed
- Low risk of complications
Additionally, don’t forget to include the start and end time of your face-to-face patient encounter. Every insurance payer requires complete documentation to verify the medical necessity of a follow-up visit.
Verify Payer-Specific Rules
Always adhere to payer-specific requirements when billing CPT code 99308 to avoid complications. Be sure to verify each payer’s individual guidelines. For example, Medicare applies a telehealth limitation to this code, allowing only one telehealth visit every 30 days.
Summary
Justify your code choice with complete documentation! CPT code 99308 is one of the E/M codes, but for a follow-up visit in a nursing facility. To summarize, you can use this code to bill for an expanded-problem-focused face-to-face resident encounter involving medical decision-making of low complexity. For example, when a patient is responding inadequately to a treatment or when you are evaluating and managing a minor complication.
We have covered everything in this blog, including the code’s description, application, modifier usage, billing tips, and documentation requirements. However, if you still need a professional to investigate your denial issues, consider choosing a billing company with reliable nursing home billing services.
