Understanding SNF CPT Codes for Physician Billing

What are SNF CPT codes? CPT codes (Current Procedural Terminology codes) are primarily used by physician offices to identify and bill for specific patient services and procedures. In some cases, skilled nursing facilities may use CPT codes to bill for physician visits but not for the procedures. 

When a patient is admitted to a healthcare provider like a physician’s medical practice, the physician will diagnose and treat the patient’s health condition. Afterward, either the physician or a medical coder will assign a specific diagnostic CPT code for that health condition and use the same code to bill a patient for the services rendered, ensuring the service or procedure is recorded and billed accurately. 

Besides using CPT codes to facilitate medical billing services, the codes are also used to gather statistical information about the frequency of procedures performed across the country. This allows healthcare administrative management services to use the CPT codes for claims processing and developing guidelines for medical care review.

CPT Codes Categories

Medical services are often covered under a patient’s insurance company or through government benefit providers like Medicare or Medicaid. Many SNF CPT codes, also known as Category I codes (99091 to 99499), are typically 5-digit codes used for the most common medical procedures and services. 

The most frequently used SNF CPT codes are in the Evaluation and Management Services (E/M) section, which include:

• Consultations
• Counseling
• Emergency department visits
• Examinations
• Inpatient hospital visits
• Newborn care
• Office visits
• Other patient care services

The above services only represent one section within the Category I codes. There are five additional code sections, including:

• Anesthesia Services (01000 – 01999): This covers anesthesia services and procedures for specific body areas, such as:
  • Head
  • Neck
  • Spine
  • Spinal cord
  • Upper leg
  • Elbow 
• Surgery (10021 – 69990): Procedures include:
  • Auditory surgical procedures, such as ear and temporal bone
  • Operating microscope procedures
• Radiology Services (70010 – 79999): These services include:
  • Diagnostic imagining
  • Ultrasound procedures
  • Radiologic guidance
  • Breast mammography
  • Bone and joint studies
  • Radiation oncology treatment
  • Nuclear medicine procedures 
• Pathology and Laboratory Services (80047 – 89398): Procedures include:
  • Organ or disease-oriented panels
  • Therapeutic drug assays
  • Evocative and suppression testing
  • Clinical pathology consultations
  • Urinalysis
  • Molecular pathology
  • Genomic sequencing
  • Other molecular multianalyte assays
  • Multianalyte assays with algorithmic analyses
  • Chemistry procedures 
• Medical Services and Procedures (90281 – 99607): Services include:
  • Immune globulins, serum, and recombinant products
  • Immunization administration for vaccines and toxoids
  • Psychiatry
  • Biofeedback
  • Dialysis services and procedures
  • Gastroenterology
  • Ophthalmology
  • Special otorhinolaryngologic
  • Cardiovascular procedures

With so many SNF CPT codes, it is imperative for physician offices and skilled nursing facilities to provide adequate training for their CPT coders, giving them a better understanding of the medical terminology and CPT codes, thus, minimizing billing errors, reducing confusion, and improving medical care and services. 

Failure to do so can result in CPT coders documenting the wrong codes, resulting in inaccurate patient medical records, leading to patients having more expensive or unnecessary procedures and inflated medical bills.

CPT Code Modifiers

Besides the generic five-digit CPT codes mentioned above, there are also CPT code modifiers, which are two-digit codes added to the original CPT codes to provide additional information. 

Code modifiers are vital because they impact the accuracy of billing services in cases like the following examples: 

• A physician performs multiple surgical procedures simultaneously, and the CPT coder must select the applicable CPT codes for all procedures. 
• A procedure takes longer than the physician’s estimate. In this case, the CPT coder must also consider timing and bill each procedure according to the time each procedure takes to complete. 
• The specific codes used in physician offices and skilled nursing facilities vary depending on the services provided and the patient’s needs. 

Failure to use modifiers can result in excessive medical bills and inaccurate facility reimbursements, leading to financial instability.

Why are CPT codes and their modifiers so important? Standardized CPT codes facilitate better communication and data exchange between healthcare providers, caregivers, and payors, ultimately improving patient care, coordination, quality, and safety. 

Furthermore, when these standardized codes are entered into a physician’s office or a skilled nursing facility’s long-term care software system, caregivers can observe the care services provided. At the same time, healthcare providers can share information more easily with other providers, payors, and regulatory agencies, leading to better patient health outcomes.

Changes in CPT Code 99306 and Other Codes

SNF CPT codes have been used since the American Medical Association (AMA) introduced them in 1966. As mentioned above, CPT codes, like CPT Code 99306, are used as the primary medical language between caregivers, providers, and payors, ensuring medical procedures and services are carried out seamlessly and billed accurately. 

However, CPT codes have been revised, expanded, and updated several times to reflect changing clinical practices while incorporating the latest technological innovations like senior care software systems that improve care delivery and medical records accuracy. 

Recently, CPT code updates were implemented, which mainly impacted E/M services, including:

• Patient history and physical examinations: Certain elements of patient history and physical examinations have been eliminated, meaning that some aspects of a patient’s history and physical exam no longer fall into the E/M section. Therefore, physicians must only document medically appropriate information for clinical practice, professional liability, and quality measurement.
• Medical decision-making table revisions: The revision of the medical decision-making table ensures a more accurate reflection of the cognitive effort involved in providing evaluation and management services.
• Expanded time total limits for physicians: Physicians are no longer constrained to consider only the time spent on patient counseling when determining the level of E/M services. This means they can now factor in the total time spent providing care to the patient on the day of the encounter, including both face-to-face and non-face-to-face interactions by the physician or qualified healthcare professional (QHP).

Other changes to CPT codes include CPT code 99306 and an Evaluation and Management (E/M) code. This SNF CPT code is used by a physician or other qualified healthcare professional in a physician’s office or a nursing facility setting to determine which parts of a face-to-face visit are deemed medically necessary and thus covered by Medicare payments. 

This means that whatever medical notes a physician may record, only the services needed for the patient’s specific condition during the visit will be considered when deciding the level of medical care for any services provided.

Furthermore, when it comes to billing Medicare for services rendered, healthcare providers and physicians are restricted to using one of two types of documentation guidelines during a patient’s visit:

• Comprehensive History: This includes documenting the patient information on the following:
  • Reason for admission
  • An extended history of present illness (HPI). This must consist of four or more HPI elements 
  • A review of the related problems identified in the HPI
  • Medically-necessary review of all body systems’ history
  • Medically-necessary review of the patient’s past, family, and social history
• HPI – History of Present Illness: This includes a chronological description of a patient’s health issue, from its development to the present condition, documenting illness information, including:
  • Severity
  • Location
  • Timing
  • Quality
  • Duration
  • Context
  • Modifying factors
  • Associated symptoms related to the presenting problem

While healthcare providers and physicians cannot mix and match elements from both sets of guidelines, they need to be aware and keep updated with the most recent code and guideline changes, minimizing their impact on services, payor policies, and regulations. 

Furthermore, this careful attention to detail will improve documentation accuracy while advocating for fair reimbursement rates, as the correct information is entered into the long-term care EHR software system.

Contact us here to see how our long-term care software can improve the accuracy of your CPT coding.

5 Benefits of Using EHRs for CPT code 99308 and More

Due to the wide range of care and rehabilitation services offered in physician offices and skilled nursing facilities, there are a great number of SNF CPT codes, including the CPT code 99308, which was formerly used to ensure that physician E/M visits are medically necessary and in line with the Medicare Part B payment policy for accurate billing and proper physician care.

However, SNF CPT codes are updated regularly, making it difficult for physicians, caregivers, and healthcare providers to stay on top of recent changes. This is where innovative technology like elder care software comes into play. 

Long-term care EHRs provide caregivers with a digital version of patients’ medical records, allowing them to be accessed simultaneously by authorized personnel in real time. 

Advanced eMAR software has tools that can be used to document patient visits, track medication orders and distribution, manage laboratory and imaging results, and analyze the evaluation and management services in a nursing facility, thus allowing healthcare providers to identify trends, patterns, and accurate costs in care delivery to make data-driven decisions.

Given the many efficiencies that long-term care software programs can bring to healthcare providers, we will now take a deeper dive into the benefits of using care plan software technology with CPT codes, like the CPT code 99306, and see how the software improves patient care outcomes while facilitating accurate billing.

1. Enhance Care Coordination 

Long-term care EHRs are used alongside nursing home CPT codes to improve care coordination among healthcare providers, including primary care physicians, specialists, and therapists, by allowing them to share information about the patient’s medical history, care plan, and treatment progress. Having more organized and legible notes helps to reduce medical errors, prevent duplicate testing, and avoid harmful medication errors that are detrimental to a patient’s health.

2. Facilitate Clinical Decision-Making 

Nursing home software can provide clinicians with improved access to CPT codes, the most recent guidelines, best practices, and clinical decision-support tools to help them make informed decisions about patient care. This also improves the accuracy of patient diagnoses, reduces unnecessary testing, and improves patient outcomes with more personalized and tailored care plans.

3. Improve Communication 

Nursing home management software improves communication between healthcare providers, caregivers, payors, and patients by allowing providers to share test results, treatment plans, and medication instructions promptly and efficiently. Patients can also access their health records, review test results, and communicate with their healthcare providers through a patient portal, thus improving patient engagement and satisfaction.

4. Evidence-Based Decision-Making 

Long-term care pharmacy software provides decision-support tools, such as helpful alerts and reminders set by caregivers around evidence-based guidelines for better patient care. This helps clinicians make informed patient care decisions, leading to improved patient outcomes and more accurate SNF CPT coding for accurate billing.

5. Enhance Patient Safety 

Nursing computer software improves patient safety by reducing the risk of medication errors and adverse drug reactions. Long-term care EHRs can flag potential drug interactions or allergies, ensuring patients receive the appropriate medication and reducing the risk of harm.

Using long-term care software with CNF CPT codes, facilities and caregivers can improve patient care outcomes by facilitating accurate and complete documentation in real time. 

The Importance of SNF CPT Codes

In conclusion, SNF CPT codes are primarily essential for identifying and billing patient services in physician offices and, in some cases, in skilled nursing facilities. SNF CPT codes can be categorized into five sections, covering specific medical procedures and services, and they facilitate statistical medical information for developing guidelines for medical care review.

When used alongside technological innovations like senior care software systems, these codes ensure that healthcare providers in physicians’ offices and elsewhere are minimizing billing errors and confusion by providing accurate medical records. 

Additionally, utilizing these codes, along with adequate training for caregivers and medical coders, results in improved medical care delivery, tailored services, correct medical records, billing accuracy, and compliance with regulations.

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