Avoid denials: Don’t bill prolonged services with a nursing home encounter

Why This Topic Matters

Nursing facility E/M reporting is commonly affected by CCI edits and bundling changes, so understanding the scope of these updates helps practices reduce claim denials and billing errors. The article is relevant to organizations that code nursing home encounters, prolonged services, and related E/M services.

Article Sections

1. Question and answer on prolonged services and nursing facility codes

   An introductory discussion of the reader’s question and the broader issue of how prolonged service reporting intersects with nursing facility E/M billing.

2. Background on prolonged service reporting and related E/M services

   A general overview of the prolonged service concept, the types of services discussed, and the broader E/M code families referenced in the article.

3. CCI edit changes in 2017

   A summary of the edit updates discussed in the article, including timing and the general categories of services affected.

4. Practical impact for nursing home billing

   A discussion of the denial risk and operational implications for claims involving nursing facility encounters.