Family Practice Coding: Can One See Snf Patients

By Author: Angela Martin
Total Articles: 206
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A long-time patient of ours now lives in a skilled nursing facility (SNF). She wants to keep on visiting our office even though the nursing facility has physicians who would see her. Can we still see her, and if so, do we bill anything differently?


Well, yes she can still see your physicians in their office and you should bill her visits as usual. Complications might crop up; but then with any diagnostics your physicians run while she's in the office (say for instance EKG or spirometry tests). Now that she's a skilled nursing facility resident, she falls under guidelines for the consolidated billing for nursing homes. This means that Medicare pays the nursing facility for the technical part of some diagnostic tests. Get to know what diagnostics the guidelines cover so you can accommodate with your billing.


For instance, the patient has an EKG in your office. You should report 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) to Medicare. Send the nursing facility a bill for 93005 ( tracing only, without interpretation and report) so that they ...
... can pay your doctor for his service.


You would handle spirometry tests in a similar fashion, however include modifiers to distinguish your physician's role. Bill Medicare with 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and append modifier 26 (professional component). Then bill the nursing facility with 94010-TC (Technical component).


Yet another note: Your physician can also see her in the nursing facility. If so, bill the nursing home codes (including 99304-99306 for initial care and 99307-99310 for subsequent care) and location place of service 31, SNF).


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