General Surgery Coding Alert - 2010 Issue 4
NURSING FACILITY CARE: Prepare Now: One MAC Institutes Pre-Pay Edit for Code 99310
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Article Overview
This piece explains a Medicare administrative contractor’s review of nursing facility care claims and why the findings led to increased payer scrutiny for a specific evaluation and management service. It is aimed at coders, billers, and clinicians who report nursing facility visits and need to understand the general documentation and time-reporting topics tied to this service category.
Why This Topic Matters
The article highlights how payer audits can trigger prepayment edits and why accurate documentation matters for nursing facility care reporting. It helps readers recognize the broader compliance issues involved in E/M coding for post-acute and long-term care settings.
Article Sections
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Audit findings and payer response
Summarizes the contractor review of nursing facility care claims and the resulting payment control action. The section frames the compliance concern that prompted the article.
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Documentation considerations for reporting the service
Covers the general documentation areas discussed in connection with the nursing facility care code, including the types of clinical support mentioned in the article. It focuses on the broad recordkeeping themes relevant to E/M reporting.
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Time-based reporting considerations
Describes the article’s discussion of reporting the service based on time and the related documentation emphasis. It addresses the general concept of time documentation for this setting.
What You Will Learn
- Why a Medicare contractor review of nursing facility care claims led to a prepayment edit
- What broad documentation themes are discussed for this nursing facility E/M service
- What the article says about time-based reporting documentation in this setting
- Who may find the article useful when reviewing nursing facility care coding practices
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians and nonphysician practitioners
- Long-term care and nursing facility billing staff
Codes Discussed
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