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March 25, 2023

Codes for visits in assisted living

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Question:

In 2023, how will we code for visits in assisted living?

Answer:

January 1st 2023, the codes for boarding home, rest home and domiciliary care are gone from the CPT® book. What are the codes for visits in assisted living in 2023 and beyond?

Home and residence services (99341—99345 for new patients) and (99347—99350 for established patients) are used for both settings. The definition of home includes a private residence, temporary lodging or short term accommodation, including hotel, campground, hostel or cruise ship. The codes are also used for people in “assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.”

A patient in assisted living is reported with these codes.

What about patients in continuing care facilities? These are facilities that include both private apartments, condos and homes and assisted living units with support. CPT® doesn’t talk about continuing care facilities, but these often include both completely independent living (home) and supportive care in assisted living. Since the same set of codes are used, does it matter?

Yes, because you still need to select the correct place of service.  The place of service code for a home visit is 12. The place of service for assisted living is 13.  Both are considered non-facility settings and Medicare pays claims in both settings at the non-facility rate.

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CPT® is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

 

Last revised October 20, 2022 - Betsy Nicoletti
Tags: CPT updates

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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