tci Medicare Compliance & Reimbursement - 2011 Issue 7
Reader Questions: Know How to Report Nursing Home Visits
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Article Overview
This reader Q&A discusses how nursing home and nursing facility visits may be reported when the circumstances do not support the usual initial visit code selection. It is aimed at physicians, coders, and billing staff who handle evaluation and management reporting for Medicare, commercial, and private payers. The article also touches on payer-specific handling and the role of supporting documentation in these situations.
Why This Topic Matters
Nursing facility E/M reporting can vary by payer, and choosing the wrong visit category can affect claim processing and documentation requests. Understanding the general options discussed in the article helps practices recognize when a payer may expect alternate reporting or additional records review.
Article Sections
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Question
Introduces the billing scenario involving a physician visit to a nursing home and the question of how the service should be reported.
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Answer
Summarizes the general reporting options discussed for nursing facility evaluation and management visits and notes that payer policies may differ.
What You Will Learn
- How this nursing facility visit scenario is framed for billing purposes
- Why payer policies can affect reporting options
- What kinds of documentation issues may be involved in evaluating the service
- How the topic relates to Medicare and other payer types
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance staff
Codes Discussed
Code Ranges Discussed
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