Did you know nearly 1.2 million residents were in certified nursing homes in 2022 across the United States? These nursing homes offer care to individuals of different ages. These include regular health checkups performed by healthcare experts. However, the main question that arises here is how the billing for these visits in nursing homes is done. That’s where CPT code 99309 is highly useful.
If you are unsure what this code signifies, do not worry. We, at NeuraBill, will cover everything you need to know about this code and its requirements.
But before that, let’s brush up on some basics.
CPT Code 99309 – Description
Primarily, CPT code 99309 reports a routine follow-up visit and care management following the initial post-admission assessment to a nursing facility. Moreover, the healthcare provider typically conducts a 30-minute encounter within a single day.
What Does It Involve?
The follow-up visit involves everyday management and evaluation of a patient under care in a nursing facility. This evaluation primarily addresses medical conditions (existing or emerging), and their treatment or management. So, in simple terms, the visit includes a moderate level of medical decision-making.
But where can CPT code 99309 be used?
Appropriate Use Cases for CPT Code 99309
Healthcare professionals may use CPT code 99309 in various circumstances. Here are a few use cases that apply here.
Care After Operation
Consider a 65-year-old male who has undergone arm surgery after a dangerous fall. He is admitted to a skilled nursing facility for post-surgical recovery, where the healthcare provider visits for a follow-up. His visit includes assessing the progress of physical therapy, the incision site, and the levels of pain.
While the decision-making involved in such cases is moderate, the medical expert adds a medication regimen to the treatment.
In this case, CPT code 99309 is valid.
Type 2 Diabetes
Now, let’s consider a 69-year-old woman suffering from type 2 diabetes for 3 years and residing in a nursing facility. The woman exhibits some new symptoms, like extreme hunger and unexplained weight loss, and has a 30-minute encounter with a healthcare professional for treatment.
The healthcare professional checks the woman’s glucose levels, evaluates the current medication plan, and rules out external factors for these symptoms. During the visit, he also recommends exercise, a balanced, high-protein diet, and lifestyle changes to manage the medical condition.
CPT code 99309 is applicable in this case.
Xerosis (Skin Dryness)
Now, imagine a routine follow-up in a nursing home setting where the health professional notices a 57-year-old man with xerosis. The patient’s skin has a cracked appearance, specifically on the limbs.
The patient also reports severe itching in these areas. The healthcare professional suspects that his medication (diuretics or water pills) is causing skin dryness. To rule out other underlying conditions, such as hypothyroidism, chronic kidney disease, or diabetes, he orders some lab tests. The results come out negative. Therefore, the patient’s medication list is reviewed and revised to curb xerosis.
Since a moderate level of medical decision-making is involved, this case will be billed with CPT code 99309.
Modifiers to Append with CPT Code 99309
The following are some of the modifiers that may be appended to this code if the service was rendered virtually via a HIPAA-compliant telehealth platform.
Modifier 93
Modifier 93 represents synchronous telehealth services provided in real time. However, when appended to CPT 99309, the modifier signifies that the service was an audio-only evaluation and management for a patient admitted to a skilled nursing facility.
The modifier has been effective since January 1, 2022, and requires the same documentation as a face-to-face encounter.
Modifier 95
When healthcare experts use real-time audio and video telecommunication for patient assessment and interaction, modifier 95 should be used. This was introduced in 2017 and can be used for both new and established patients.
Modifier GT
Like modifier 95, modifier GT indicates services rendered via audio-video communication. However, 95 is the modern code and is used for most CPT billings. Conversely, GT is an older telehealth modifier.
Quick Insight:Modifier 95 and GT signify a telehealth service. However, modifier 95 is the modern standard, and billers must use the Place of Service (POS) Code 02 to support its usage. Some private payers still approve GT in specific circumstances.
Modifier GQ
If the physician or health expert performs subsequent visits using an asynchronous method (i.e., not shared in real time), then modifier GQ is used. In such cases, the system gathers and records information and shares it with the physician for review later.
However, you must note that this permission may be limited to practitioners rendering an asynchronous telehealth service in Alaska and Hawaii.
Reimbursement Guidelines for CPT Code 99309
The following are the main reimbursement guidelines for CPT code 99309:
Submit the Required Documents
Detailed documents are necessary for reimbursement of services represented by CPT code 99309. These documents should reflect a moderate level of medical decision-making.
Your supporting documentation should include the total time of that encounter, as well as details of the performed medical activities, such as medication review, lab work, and counselling.
According to the Medicare Documentation Checklist for 99309, your paperwork should include:
- Chief complaint or the reason for the subsequent visit.
- Extended history of present illness.
- Extended review of systems.
- Patient’s past, family, and social history relevant to the problem.
- Details of the physical exam.
- Total time for the face-to-face encounter.
- Provider’s dated and signed report.
Consider Payer-Specific Details
The reimbursement rate and billing rules for CPT code 99309 may vary for each payer. Thus, it is crucial to establish clear communication with the payer. This assists with the reimbursement and billing process and aids compliance during claim submission.
Be Wary of Billing Frequency Limitation
Medicare has suspended telehealth frequency limits on subsequent nursing facility visits. However, federal regulations require that nursing facility residents be seen by a healthcare professional at least once in 30 days within the first 90 days of admission. After that, subsequent evaluation and management visits must occur once every 60 days.
Summing It Up
With that, we covered all crucial information related to CPT code 99309, including its billing and reimbursement guidelines. Before we wrap everything up, let us do a quick review.
We discussed that this code is applicable to a follow-up visit in a nursing facility involving moderate-level medical decision-making. We also discussed some modifiers that apply to 99309 and how they specify the circumstances in which the service was performed.
However, if you still find medical billing challenging, NeuraBill is the answer. With our nursing home billing services, we streamline medical coding and accelerate claim submission and revenue collection.
