If a patient is re-admitted to a nursing facility after an inpatient stay, should we bill an initial nursing facility visit or a subsequent nursing facility visit?
I looked at the current CPT® book and the 9th edition of Principles of CPT® Coding to find an answer to this question.
CPT® does say that the codes are used for admission and re-admission. Here are some instances when I would charge an initial nursing facility care code:
- If the inpatient admission was for a new condition, and a re-assessment and change in treatment plan was needed.
- For a significant exacerbation in the patient’s existing conditions, that requires a change in treatment plan.
- Principles of CPT® Coding describes the nursing facility’s requirement for a resident assessment protocol when the patient has had a major, permanent change in status. If this change in status was concurrent/followed the hospitalization, I would report an initial code.
Of course, every case is different, but I would be more inclined for a subsequent nursing facility visit for:
- ED and observation care
- Short inpatient admissions
- Inpatient admissions that did not result in a change in treatment plan