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Plus: Nail down the right SNF visit codes.

When your primary care provider sees patients in skilled nursing facilities (SNFs), rest homes, or  hospice care, you may find it challenging to select the most appropriate codes. After all, the evaluation and management (E/M) coding instructions have changed multiple times in the past five years, and several essential codes for nursing and hospice facilities were deleted.

Discover a few facts about coding these visits so you can make sure you鈥檙e collecting for these time-intensive, often complex visits.

Look to 99304-99306 for Initial Nursing Facility Visits

When the provider sees a patient in a skilled nursing facility (SNF), you鈥檒l need to know whether the service was for an admission, a subsequent visit, or a discharge.

For skilled nursing facility admissions, you鈥檒l choose one of the following codes:

• 99304 (Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded)
• 99305 (鈥�moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded)
• 99306 (鈥�high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded)

Some payers will only reimburse the codes from this series for physicians, and not for physician assistants, nurse practitioners, or other providers. However, there are exceptions, so contact your insurer for information about who can bill these codes.

Example: Suppose your primary care physician admits a patient to a nursing facility. The physician spends 15 minutes examining the patient and going over her medical history, five minutes talking to the patient鈥檚 previous provider, and another five minutes speaking with the patient and their family about their diagnosis and care. For this nursing facility admission, you鈥檇 report 99304, since the physician spent a total of 25 minutes.

Eye 99307-99310 for Subsequent SNF Visits

Once the patient has been admitted to the SNF, the remaining E/M visits should be coded as subsequent care. For these visits, you鈥檒l report one of the following codes:

• 99307 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded)
• 99308 (鈥�low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded)
• 99309 (鈥�moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded)
• 99310 (鈥�high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded)

It鈥檚 important to note that 99318 (Evaluation and management of a patient involving an annual nursing facility assessment鈥�) was deleted in 2023. Going forward, if you perform an annual exam in a SNF, you鈥檒l report the appropriate code from the subsequent nursing facility visit range.

For example: Suppose your provider performs an annual exam for a patient in a nursing facility. The documentation supports a moderate level of medical decision making. For this visit, you鈥檒l report 99309.

Examine 99341-99345 for New Nursing Home Patients

If you see a new patient in a rest home, also called a nursing home, your coding will change. In these cases, you鈥檒l submit a code from the 99341-99345 range. These codes describe care that your physician provides to a patient living in a non-skilled rest home. This may also be called independent living or assisted living:

• 99341 (Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded)
• 99342 (鈥�low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded)
• 99344 (moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded)
• 99345 (鈥�high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded)

Example: Suppose your physician visits a new patient at an assisted living facility to evaluate sinus pain. The physician spends 30 minutes on the visit, diagnoses the patient with sinusitis, and submits a prescription for amoxicillin. In this situation, you鈥檇 99342 based on the time spent with the patient.

Look to 99347-99350 for Subsequent Nursing Home Visits

Once the nursing home patient is established, you鈥檒l select a code from the 99347-99350 range, which features these codes:

• 99347 (Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded)
• 99348 (鈥�low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded)
• 99349 (鈥�moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded)
• 99350 (鈥�high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded)

Example: The physician visits an independent living home and evaluates an established patient who has been coughing up green phlegm up to 12 times a day. The patient also has stable diabetes, hypertension, high cholesterol, and a history of heavy smoking. The provider diagnoses the patient with an upper respiratory infection and prescribes Levaquin and a steroid pack. The doctor also requests a consult for the patient with a pulmonologist. Due to the moderate level of decision making, the provider reports 99349 for the visit.

Check Modifier 25 for Separate Services

You may be able to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to your SNF and rest home codes if the physician performs a separately identifiable service along with a procedure. Make sure the documentation supports the separate nature of the procedure and the E/M to justify using this modifier.

Be sure to confirm that modifier 25 is allowable with the SNF and nursing home codes by contacting your payers directly and getting their guidelines in writing.

Remember Modifiers GV, GW for Hospice Patients

When a patient is being cared for under Medicare鈥檚 hospice benefit, most of the care they receive is billed through the hospice provider, and nearly everything is included in this payment. But there may be circumstances when your physician treats a hospice patient for another service.

For instance, , and some care plan oversight services can be billed separately from the hospice benefit. Plus, the patient may require care unrelated to their terminal illness. In these situations, your provider can bill for their services, but must use one of the following two modifiers:

• Modifier GV (Attending physician not employed or paid under arrangement by the patient鈥檚 hospice provider)
• Modifier GW (Service not related to the hospice patient鈥檚 terminal condition)

You鈥檒l use modifier GV if your physician is performing care related to the patient鈥檚 terminal illness, but the physician isn鈥檛 paid through the hospice. And you鈥檒l append modifier GV to the claim if your physician performed a service that had nothing to do with the terminal illness.

For instance, suppose the patient falls out of bed and fractures their arm, causing severe pain. Your physician stabilizes the fracture, which is unrelated to their terminal diagnosis of chronic obstructive pulmonary disease (COPD). In this case, your provider can report the fracture care code with modifier GW appended to collect for the service.

Torrey Kim, Contributing Writer, Raleigh, NC