TMPPM 2010 > Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook > Physician > Procedures and Services > Physician Evaluation and Management (E/M) Services > Inpatient Hospital Services

   
 

6.3.50.6.6 Nursing Facility Services

Providers must use the following when billing initial nursing facility assessments, subsequent nursing facility care, and annual nursing facility assessments in a nursing facility:

Procedure Codes

99304*

99305*

99306*

99307

99308

99309

99310

99315

99316

99318

* Initial nursing facility assessments include all services related to an admission to the nursing facility.

Comprehensive initial nursing facility assessments performed by the same provider for the same diagnosis are limited to one every six months. The second initial nursing facility assessment within the six-month period will be denied.

Prolonged services in the nursing facility involving direct (face-to-face) patient contact that is beyond the usual service may be reimbursed on the same day as a nursing facility visit (procedure code 99304, 99305, 99306, 99307, 99308, 99309, or 99310).

Procedure code 99356 must be used to report the first hour of prolonged service and is limited to one per day.

Procedure code 99357 must be used to report each additional 30 minutes and is limited to a quantity of three units or one and one-half hours per day.

Prolonged physician services will not be reimbursed in addition to an emergency room visit billed on the same day.

The following initial nursing facility assessments, subsequent nursing facility care, or nursing facility discharge day management procedure codes billed by the same provider with the same date of service as initial hospital care (procedure code 99221 or 99223) are denied as part of another procedure billed on the same day:

Procedure Codes

99304

99305

99306

99307

99308

99309

99310

99315

99316

All E/M services, regardless of setting, are considered part of the initial nursing facility care when performed by the same provider on the same day as the admission.

Subsequent nursing facility care E/M procedure codes 99307, 99308, 99309, and 99310 are limited to one per day regardless of diagnosis.


Texas Medicaid & Healthcare Partnership
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