We are all aware that CPT codes are essential for medical billing. Today, we will discuss the billing codes for discharge management services. In 1998, two new codes for discharge services were added, along with revisions to the Nursing Facility E/M Services codes.
CPT code 99315 is especially used to report the management services provided by the physician or other qualified healthcare practitioner on the patient’s discharge day. In this blog, we will discuss the code’s description, payer-specific recommendations, documentation advice, and typical situations in which this code is applicable.
CPT Code 99315 – Description
CPT code 99315 reports discharge management services when a patient is officially released from a nursing home. A physician, or other certified healthcare provider, performs the release services. These services include the time and work required for the patient’s final physical examination, documentation, patient instructions, and continuing care coordination. However, these services cannot exceed 30 minutes.
Scenarios Where CPT Code 99315 is Applicable
Below are some real-life examples where CPT code 99315 can be rightly applied, which you may read for better understanding.
Completion of Short-Term Physical Therapy
Consider a case of a 65-year-old man. He underwent knee surgery and was temporarily admitted to a skilled nursing facility for physical rehabilitation. During his stay, he religiously attended therapy sessions for several weeks. At the time of his discharge, the medical professional looked over his medication list and assessed his mobility. During the discharge, he ensured there was no swelling and discussed care techniques, such as a gradual return to exercise and mild stretching. This discussion carried on for twenty-five minutes. Therefore, the healthcare provider may submit their claim using CPT code 99315 for discharge services.
Continuation of Diabetic Care
Consider a different situation in which a 68-year-old woman has Type 2 diabetes. She was admitted to a skilled nursing facility for wound care after developing a foot ulcer. The physician got ready to release her after her wound had healed. During their 28-minute discharge consultation, he reviewed the woman’s diabetes medicines, taught her how to check her blood sugar at home, and stressed the importance of keeping her feet clean to avoid infections. Because the total discharge time, including social and medical coordination, was less than thirty minutes, the physician invoiced CPT code 99315 for this release-day management service.
Applicable Modifier for CPT Code 99315
The following modifier may be appended to CPT code 99315 for enhanced coding specificity.
Modifier FS
The FS modifier indicates a split or shared evaluation and management (E/M) visit in a facility, showing that a physician and a non-physician practitioner worked together. So, you may append modifier FS to CPT 99315 if the physician and his assistant or a nurse practitioner carried out the discharge management services.
CPT Code 99315 – Billing & Reimbursement Guidelines
Now is the time for some essential billing guidelines that will help you file clean claims against CPT code 99315.
Ensure Detailed Documentation
Your documentation plays a vital role in your reimbursement. It is necessary to guarantee correctness and compliance for successful payment. So, you must be careful with paperwork while billing for CPT code 99315.
The provider’s notes should include all pertinent information about the patient’s last evaluation and care plan, as well as a clear indication that a nursing facility discharge service was carried out. The documentation must represent a concluding assessment of the patient’s condition, along with a summary of the hospital stay. Below is the list of some other details your documentation must contain:
- Date and time of discharge.
- Duration of service (time spent).
- Summary of facility stay.
- Patient’s current condition at discharge.
- Medication list and changes.
- Follow-up instructions and care coordination details.
- Provider’s signature and credentials.
Remember, detailed documentation ensures compliance and helps you avoid denials and audits.
Follow the Payers’ Guidelines
I nsurance payers have established certain requirements that must be met to bill your services with CPT code 99315. The Medicare Part B payment criteria (quoted in CMS Manual) state that to be eligible for the skilled nursing facility/nursing facility discharge management service, the patient must have a direct consultation with a trained non-physician practitioner (NPP) or a physician.
Secondly, even if the patient is released from the facility on a separate date, the physician or qualified NPP should bill for the E/M discharge day management visit on the day it was conducted. Additionally, CPT code 99315 may be used to bill the discharge day management service for a deceased patient, but only if the physician or certified NPP was involved in the death pronouncement.
Final Word
Physicians or other qualified healthcare providers can bill discharge day management services using CPT code 99315 when the total time spent is 30 minutes or less. These services usually cover final evaluation, post-release care coordination, patient education, and discharge planning. We tried to cover every essential detail that you should be aware of for accurate billing and reimbursement of a facility discharge management service.
However, if you are still questioning whether this information is sufficient, instead of making billing mistakes, consider specialized nursing home billing services to prevent errors. You can then delegate all of your billing responsibilities to a qualified medical biller.
