: Nursing Home vs Office Codes RVU's --> better pay seeing them in the nursing home?

[Guest guest]

OK, here is the deal:

Nursing homes and Assisted Living Facilities (Domiciliary) are 2

totally different settings. You have use the matching POS and 99xxx

codes.

First let me tell you my experience with Assisted Living Facilities---

pays much higher--for the equivalent of 99214, office visit pays $86,

and Assisted Living codes( 99336) pay $107. But not worth it, believe

me. I worked at 2, when I first started practice, and quickly built

up to 40-50 patients. It was a NIGHTMARE. Way worse compared to NHs.

That is because, the nurses are not allowed to take verbal/phone

orders. Every single order has to be manually signed, even stupid

things like: say you raise the dose of Colace from 100 to 200mg, you

have to send an actual Rx for the 200mg, then another signed Rx: " D/C

Colace 100mg dose " . Even Aspirins and Multivitamins need Rxs. For

antibiotics etc limited day Rxs, they would pester me to rewrite the

Rx stating: " ....for 10 days, then stop " . They do not measure

fingersticks or check BP. There is generally 1 nurse who is so bogged

down with paperwork that she had no knowledge about the patients. I

could not use my handy e-fax, because they needed manual signatures.

I felt totally harassed, quit both, and increased the NH load. Phew!

Now NH: (codes 99304-99310, and D/C code are separate): for a monthly

medication review and renewal, 99309--equivalent of 99214--pays about

what your excel file states, probably a little less in our area, I

have to look it up. But each visit goes so fast once you get to know

the patient. We have been given a form to address the key issues the

State is looking for. I fill in the various fields by hand (they did

not want me using my computer, and the form actually saves me a lot

of time). I review labs, consults, examine the patient, and do the

note in 15 min or less per patient. The nurses do all the work, no

scripts need to be written--just in the order section. Then there are

a lot of really quick visits--rashes, conjunctivitis, not eating

well, behavior issues, UTIs etc, that you can bill for, as you are

required to write a note anyway. So if I spend about 3-4 hr, I can do

an admit, 6-7 renewals, and 3-4 problem visits ( 99307/8), sign off

on consults and labs.

No phone calls for refills from patients, no keeping track of whether

the patient went for their mammogram or Ophthal appt. Psychiatrists

round there as well, saving me a lot of time typically needed to

manage depression/anxiety. Dietitians counsel the patients, aides and

nurses know everything about them, and history taking is quick as

well. Now I am so organized, I see all the patients, review with

staff, scratch down key points, then sit down and do all the notes.

--Padma

>

> Out of curiosity, I looked up the RVU's for office and nursing home

codes.

>

> These are from 2006.

>

> Link to an Xcel file is in the pdf located here...

>

>

http://www.acc.org/advocacy/pdfs/2006RVUsandNationalAverageMedicarePay

ments1

> 22305.pdf

>

> If I'm reading this correctly, does the similar nursing home visit

(time,

> complexity, etc) pay better than the same type of office visit?

>

> Could someone who is experienced in nursing home visits please

explain and

> confirm the issues with coding nursing home visits when you see the

patient

> in the nursing home and not in the office?

>