Nursing homes play a vital role in caregiving. The American Health Care Association reports that 1.3 million individuals receive care in nursing homes or skilled nursing facilities. These people may include:
- Senior citizens
- Chronically ill individuals
- People who require assistance with everyday tasks
- Patients with severe dementia
- Other individuals requiring long-term care
The services provided in these facilities are covered by insurance payers such as Medicare or other private insurers. However, to bill these services and claim your reimbursement, you must use the correct nursing home CPT codes.
Among these codes, CPT code 99308 specifically covers a subsequent care visit at a nursing facility. Continue reading to uncover the details.
CPT Code 99308 – Description
According to the American Medical Association (AMA), it is a procedural code that falls within the Subsequent Nursing Facility Care code range. This means CPT code 99308 represents a subsequent nursing facility care visit that included evaluation and management (E/M) services. Moreover, the nursing facility visit involved a low level of medical decision-making.
Typically, for this code to be valid, the provider must spend 15 to 20 minutes of total time on the date of the encounter.
A Deeper Overview of CPT 99308
CPT code 99308 is used for reporting ongoing services provided to a resident of a nursing home. What’s important to note is that nursing facility care visit codes are divided into three parts, i.e., initial, subsequent, and discharge services. During each of these visits, the physician must:
- Review the patient’s problem-focused medical history
- Perform a problem-focused examination
- Make a medical decision.
Medical decision-making is also categorized based on its level of complexity: straightforward, low, moderate, and high. CPT codes are assigned based on the complexity level of medical decision-making and time spent with the patient.
- 99307: A subsequent nursing facility care visit, straightforward medical decision-making, 10 minutes.
- 99308: A subsequent nursing facility care visit, low-complexity medical decision-making, 20 minutes.
- 99309: A subsequent nursing facility care visit, moderate-complexity medical decision-making, 30 minutes.
- 99310: A subsequent nursing facility care visit, high-complexity medical decision-making, 45 minutes.
Moreover, familiarity with the CPT code is necessary before reporting it, so let us discuss some appropriate use cases for this code.
Appropriate Use Cases for CPT Code 99308
CPT code 99308 can be appended in the following clinical scenarios:
Chronic Condition Management
Imagine a 78-year-old male resident in a skilled nursing facility who suffers from controlled hypertension and type 2 diabetes.
The patient presents for routine follow-up, and the healthcare service provider spends time within the typical time range for this code, checking for:
- Blood pressure changes
- Glucose readings
- Medication adherence
Additionally, the healthcare provider performs a clinically appropriate examination and addresses a slight A1C elevation with dietary changes and a low-risk decision, continuing medication as prescribed.
No new issues arise, qualifying straightforward chronic condition management under CPT code 99308 for ongoing stability monitoring.
Post-Surgical Recovery
Consider the case of a 72-year-old recovering from knee replacement surgery in a nursing home. The provider evaluates the patient’s symptoms and functional status, and the patient reports mild pain and limited mobility during a subsequent visit.
The physician assesses mobility, incision healing, and gait in approximately 15 to 29 minutes. Afterwards, the provider makes extensive notes on the patient’s history, pain medication, and therapy.
Throughout the session, the service provider makes low-complexity decisions like adjusting anti-inflammatory drug dosages and fine-tuning the physical therapy schedule. But, since no complications are noted during the E/M, CPT code 99308 is used to report the visit.
Post-Hospitalization Follow-Up
Imagine an 85-year-old nursing facility female resident who sees a physician for a follow-up, approximately 15-29 minutes, after a congestive heart failure (CHF) exacerbation discharge. The provider reviews and documents the following:
- Weight trends
- Labs
- Symptoms (e.g., fatigue)
Next, the medical practitioner performs a clinically appropriate examination and recommends a minor adjustment in the treatment plan and sodium restrictions to manage the patient’s symptoms. He approves of patient monitoring without significant risk.
Since the case involves stable conditions with low-risk supports, the payer is billed using CPT code 99308.
Modifiers to Append with CPT Code 99308
Modifiers should be used when appropriate to bill payers when additional services are rendered to the patient on the same day as the subsequent visit.
Modifier 25
Modifier 25 is used to indicate a separately identifiable E/M service rendered to a patient on the same day as another service or procedure. When using this modifier, professionals should document the distinct nature of the services provided to avoid duplication-related claim denials.
Additionally, they should remember that the E/M service does not necessarily need a separate diagnosis from the one submitted with the procedure to use this modifier.
Reimbursement Guidelines for CPT Code 99308
Billing teams should consider the essential reimbursement guidelines for CPT code 99308 to avoid claim denials. These guidelines include:
Use the Code According to Decision-Making
Code selection for nursing home visits billing is based on the complexity level of medical decision-making or the total time spent. The patient’s history and examination are performed as they are clinically appropriate, but are not key determinants for code selection. Thus, the CPT code should be used according to either the time duration or the medical decision-making level.
For 99308, time spent should be at least 15 minutes, and the visit should involve low-complexity medical decision-making.
Bill One Visit Per Day
Typically, billing teams can charge for one visit per provider per day, unless a medically necessary additional visit is separately documented. Even then, it should be appropriately documented, as per the payer guidelines.
Using it for multiple encounters within the nursing facility without a viable reason is incorrect and will result in claim denial.
Ensure Time-Based Reporting
CPT code 99308 may be reported for 15 to 29 minutes of total time spent with the patient when and if time was used as the basis for code selection.
Use 99308 with the Accurate Place of Service Code
CPT code 99308 applies specifically to nursing facility settings and not hospitals or outpatient clinics. Using it for services provided at medical facilities other than nursing homes or skilled nursing facilities is incorrect and results in claim denial. Therefore, ensure that your pair 99308 with the most accurate place of service (POS) code.
Provide Complete Documentation
Complete documentation is the foundation of successful claim processing. In this case, the documents should also include the patient’s medical history, primary complaint, history of past illnesses, and relevant family history.
Secondly, the documents should include details of the medically appropriate examination as well as an assessment of relevant anatomical structures. Lastly, the documentation should also reflect low-risk decision-making and elements like:
- Number/complexity of problems
- Data reviewed
- Risk of complications
As stated earlier, CPT code 99308 applies to the total time spent (including non-face-to-face activities, like data review, if applicable). Therefore, the total time spent during the follow-up visit and the date of the encounter should be documented when time is used for code selection.
Wrapping It Up
To summarize, CPT code 99308 is a procedural code that reports a subsequent nursing facility care visit. It is explicitly used for services rendered in nursing facilities, for 15 to 29 minutes, and when low-level medical decision-making was involved.
Typically, modifier 25 applies to this CPT code when other distinct services are rendered on the same day. Some billing guidelines to bear in mind include:
- Attach supporting documents with the claim.
- Pair with the accurate place of service code.
- Ensure time-based reporting to justify code selection.
- Bill once per day per provider.
If your in-house billing team wants to report nursing home care visits with complete confidence, it’s necessary to ensure familiarity with this CPT code.
However, if they are not equipped or trained to bill this CPT code, we recommend opting for NeuraBill’s medical billing and coding services. These solutions can help you file clean claims and prevent revenue leakages.
