AMA CPT® Assistant - 1992 Issue 3 (Fall)
Nursing Facility Services Codes (Fall 1992)
Fall 1992 pages 34-35 Coding Clarification Nursing Facility Services Codes Physicians who provide services to patients in nursing facilities are presented with a unique environment that requires the physician to be knowledgeable in statutory and regulatory requirements for that care under Medicare/Medicaid programs. In order to facilitate the use of OPT to report physician services to patients in nursing facilities, the Nursing Facility Codes (99301-99333) were revised in CPT 1992 to reflect much of the language in the Medicare/Medicaid statutes and regulations for nursing homes. We have asked the Health Care Financing Administration (HCFA) to provide background information concerning...
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Article Overview
This CPT Assistant article provides background on the fall 1992 nursing facility services code revisions and the federal nursing home policy changes that shaped them. It is aimed at physicians, coders, and facility staff who work with nursing facility and related resident care reporting under Medicare and Medicaid. The article discusses the regulatory environment, resident assessment framework, care planning context, and the broad categories of evaluation and management services addressed by the nursing facility code family.
Why This Topic Matters
Understanding the policy and care-process background helps readers interpret why the nursing facility code family was revised and how the service categories fit within Medicare and Medicaid facility requirements.
Article Sections
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Coding Clarification
Introduces the coding update and its connection to federal nursing home requirements and the CPT revision process.
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Background and policy changes
Summarizes the Medicare and Medicaid reforms that led to a unified nursing facility framework and the related facility terminology changes.
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Scope of nursing facility services reporting
Describes the general settings and service contexts addressed by the nursing facility codes, including related facility types and visit reporting situations.
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Resident assessment and care planning
Outlines the assessment process used in nursing facilities and the broad role of assessment instruments and care planning in resident management.
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Physician participation and visit schedule
Reviews physician involvement in assessments and the general timing expectations for routine visits in nursing facility care.
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Note
Identifies that the article is part of a two-part discussion and points to follow-up clarification in the companion piece.
What You Will Learn
- How federal nursing home reforms affected the CPT nursing facility service code family
- What broad facility and care settings are discussed in relation to nursing facility reporting
- How resident assessment and care planning are described at a high level
- What general physician participation issues are highlighted for nursing facility services
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Facility administrators
- Compliance staff
Codes Discussed
Code Ranges Discussed
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