These codes are used to report initial nursing facility care services. Initial nursing facility care services provide the initial comprehensive assessment during which the physician completes a thorough evaluation, develops a plan of care and writes or verifies admitting orders for the nursing facility resident.
There are three levels of care for these services. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.
For these encounters, the level of care may be selected based on the MDM required for the visit OR based on time spent.
The rules for performing and documenting initial nursing facility care services are covered extensively in the INITIAL NURSING FACILITY CARE SERVICES course, which includes clinical examples for all levels of care as well as detailed explanations of the MDM and time required for each visit.
The 99304 level of care requires straightforward or low complexity MDM or a total of twenty-five minutes spent. This code is used for only 4.01% of these encounters among internists. The reimbursement is about $71.
The 99305 level of care requires moderate complexity MDM or a total of thirty-five minutes spent. This code is used for 31% of these encounters among internists. The reimbursement is about $119.
The 99306 level of care requires high complexity MDM or a total of forty-five minutes spent. This code is used for 65% of these encounters among internists. The reimbursement is about $163.
The rules for performing and documenting initial nursing facility care services are covered extensively in the INITIAL NURSING FACILITY CARE SERVICES course, which includes clinical examples for all levels of care as well as detailed explanations of the MDM and time required for each visit.