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

[Guest guest]

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/2006RVUsandNationalAverageMedicarePayments122305.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?

99334

Domicil/r-home visit est pat

A

0.76

99335

Domicil/r-home visit est pat

A

1.26

99336

Domicil/r-home visit est pat

A

2.02

99337

Domicil/r-home visit est pat

A

3.03

99212

Office/outpatient visit, est

A

0.45

99213

Office/outpatient visit, est

A

0.67

99214

Office/outpatient visit, est

A

1.10

===============================================

Based on the above, it would appear that one is better off seeing a 99335 (RVU 1.26) at the nursing home rather than a 99214 (RVU 1.10) in the office.

This is about a 14.5% different in RVU.

Not insignificant if one is seeing 3, 7, or 20 nursing home patients.

Plus the documentation might be less onorous.

http://www.aapmr.org/hpl/pracguide/pmrprac/cpt06.htm

99335: Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: 1. An expanded, problem-focused interval history; 2. An expanded, problem-focused examination; and 3. Medical decision making of low complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.

Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

http://www.fpnotebook.com/MAN9.htm

Established Outpatient: CPT Code 99214

Key Components (2 of 3 meet or exceed requirements)

E/M Detailed History

E/M Detailed Exam

E/M Moderate Complexity Medical Decision

Problem Severity

E/M Moderate Severity Problem

E/M High Severity Problem

Physician Time: 25 minutes

====================================================

2006 National Physician Fee Schedule Relative Value File

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

Dental codes (D codes) are copyright 2002 American Dental Association. All Rights Reserved.

REVISED February 2006

NOT USED

FULLY

FULLY

FULLY

FULLY

2006

FOR

IMPLEMENTED

IMPLEMENTED

IMPLEMENTED

IMPLEMENTED

Non

2006

STATUS

MEDICARE

WORK

NON-FAC

FACILITY

MP

NON-FACILITY

FACILITY

Facility

Facility

GLOB

CONV

HCPCS

MOD

DESCRIPTION

CODE

PAYMENT

RVU

PE RVU

PE RVU

RVU

TOTAL

TOTAL

Payment

Paymen

DAYS

FACTOR

99304

Nursing facility care, init

A

1.20

0.49

0.49

0.05

1.74

1.74

$65.94

$65.94

XXX

37.8975

99305

Nursing facility care, init

A

1.61

0.63

0.63

0.07

2.31

2.31

$87.54

$87.54

XXX

37.8975

99306

Nursing facility care, init

A

2.01

0.75

0.75

0.09

2.85

2.85

$108.01

$108.01

XXX

37.8975

99307

Nursing fac care, subseq

A

0.60

0.27

0.27

0.03

0.90

0.90

$34.11

$34.11

XXX

37.8975

99308

Nursing fac care, subseq

A

1.00

0.45

0.45

0.04

1.49

1.49

$56.47

$56.47

XXX

37.8975

99309

Nursing fac care, subseq

A

1.42

0.62

0.62

0.06

2.10

2.10

$79.58

$79.58

XXX

37.8975

99310

Nursing fac care, subseq

A

1.77

0.78

0.78

0.08

2.63

2.63

$99.67

$99.67

XXX

37.8975

99315

Nursing fac discharge day

A

1.13

0.45

0.45

0.05

1.63

1.63

$61.77

$61.77

XXX

37.8975

99316

Nursing fac discharge day

A

1.50

0.59

0.59

0.06

2.15

2.15

$81.48

$81.48

XXX

37.8975

99318

Annual nursing fac assessmnt

A

1.20

0.49

0.49

0.05

1.74

1.74

$65.94

$65.94

XXX

37.8975

99324

Domicil/r-home visit new pat

A

1.01

0.49

0.49

0.05

1.55

1.55

$58.74

$58.74

XXX

37.8975

99325

Domicil/r-home visit new pat

A

1.52

0.68

0.68

0.07

2.27

2.27

$86.03

$86.03

XXX

37.8975

99326

Domicil/r-home visit new pat

A

2.27

0.92

0.92

0.10

3.29

3.29

$124.68

$124.68

XXX

37.8975

99327

Domicil/r-home visit new pat

A

3.03

1.17

1.17

0.13

4.33

4.33

$164.10

$164.10

XXX

37.8975

99328

Domicil/r-home visit new pat

A

3.78

1.42

1.42

0.16

5.36

5.36

$203.13

$203.13

XXX

37.8975

99334

Domicil/r-home visit est pat

A

0.76

0.40

0.40

0.04

1.20

1.20

$45.48

$45.48

XXX

37.8975

99335

Domicil/r-home visit est pat

A

1.26

0.58

0.58

0.06

1.90

1.90

$72.01

$72.01

XXX

37.8975

99336

Domicil/r-home visit est pat

A

2.02

0.82

0.82

0.09

2.93

2.93

$111.04

$111.04

XXX

37.8975

99337

Domicil/r-home visit est pat

A

3.03

1.15

1.15

0.13

4.31

4.31

$163.34

$163.34

XXX

37.8975

99339

Domicil/r-home care supervis

B

0.00

0.00

0.00

0.00

0.00

0.00

$0.00

$0.00

XXX

37.8975

99340

Domicil/r-home care supervis

B

0.00

0.00

0.00

0.00

0.00

0.00

$0.00

$0.00

XXX

37.8975

99341

Home visit, new patient

A

1.01

0.48

0.48

0.05

1.54

1.54

$58.36

$58.36

XXX

37.8975

99342

Home visit, new patient

A

1.52

0.68

0.68

0.07

2.27

2.27

$86.03

$86.03

XXX

37.8975

99343

Home visit, new patient

A

2.27

0.94

0.94

0.10

3.31

3.31

$125.44

$125.44

XXX

37.8975

99344

Home visit, new patient

A

3.03

1.18

1.18

0.13

4.34

4.34

$164.48

$164.48

XXX

37.8975

99345

Home visit, new patient

A

3.78

1.43

1.43

0.16

5.37

5.37

$203.51

$203.51

XXX

37.8975

99347

Home visit, est patient

A

0.76

0.40

0.40

0.04

1.20

1.20

$45.48

$45.48

XXX

37.8975

99348

Home visit, est patient

A

1.26

0.58

0.58

0.06

1.90

1.90

$72.01

$72.01

XXX

37.8975

99349

Home visit, est patient

A

2.02

0.83

0.83

0.09

2.94

2.94

$111.42

$111.42

XXX

37.8975

99350

Home visit, est patient

A

3.03

1.18

1.18

0.13

4.34

4.34

$164.48

$164.48

XXX

37.8975

99201

Office/outpatient visit, new

A

0.45

0.49

0.15

0.03

0.97

0.63

$36.76

$23.88

XXX

37.8975

99202

Office/outpatient visit, new

A

0.88

0.79

0.31

0.05

1.72

1.24

$65.18

$46.99

XXX

37.8975

99203

Office/outpatient visit, new

A

1.34

1.13

0.48

0.09

2.56

1.91

$97.02

$72.38

XXX

37.8975

99204

Office/outpatient visit, new

A

2.00

1.50

0.71

0.12

3.62

2.83

$137.19

$107.25

XXX

37.8975

99205

Office/outpatient visit, new

A

2.67

1.78

0.95

0.15

4.60

3.77

$174.33

$142.87

XXX

37.8975

99211

Office/outpatient visit, est

A

0.17

0.39

0.06

0.01

0.57

0.24

$21.60

$9.10

XXX

37.8975

99212

Office/outpatient visit, est

A

0.45

0.54

0.16

0.03

1.02

0.64

$38.66

$24.25

XXX

37.8975

99213

Office/outpatient visit, est

A

0.67

0.69

0.24

0.03

1.39

0.94

$52.68

$35.62

XXX

37.8975

99214

Office/outpatient visit, est

A

1.10

1.03

0.41

0.05

2.18

1.56

$82.62

$59.12

XXX

37.8975

99215

Office/outpatient visit, est

A

1.77

1.32

0.65

0.08

3.17

2.50

$120.14

$94.74

XXX

37.8975

The FPM says in 2006, the codes were changed for nursing home visits...

http://www.aafp.org/fpm/20060100/28cpt2.html

Codes for care of patients in nursing facilities have undergone a major revision. Codes 99301-99303 and 99311-99313 have been deleted. New initial nursing facility codes 99304-99306 describe only the required key components and problem severity, which makes them consistent in structure with initial hospital care codes. Subsequent nursing facility care should be reported with new codes 99307-99310. Nursing facility discharge codes were not changed. A new code, 99318, for reporting nursing facility assessments has been added under other nursing facility services.

The CPT panel also made major changes in the domiciliary, rest home (e.g., boarding home) or custodial care services codes. Codes 99321-99323 and 99331-99333 have been deleted. Five new codes have been introduced for reporting new patient services: 99324-99328. These are comparable in structure to the codes for new patient office visits. New codes have also been added for four levels of established patient visits: 99334-99337. Most notable in this section are new codes 99339 and 99340, which are to be used for reporting care plan oversight provided to a patient who is not under the care of a home health agency, enrolled in a hospice or residing in a nursing facility. These two new time-based codes allow a physician to bill for complex and multidisciplinary care-plan development or revision, such as care given to chronically ill children in their home or to Alzheimer's patients in an assisted living facility.

http://www.memag.com/memag/article/articleDetail.jsp?id=359026

Rest home/NF codes

Q. Should I use the same codes when I perform an E & M service on a rest home patient as I would if the patient were in a nursing facility?

A. No. When you treat a rest home patient, use domiciliary, rest home, or custodial care service codes. For a new patient, use 99324-99328 and report established patient visits with 99334-99337.

Claim NF services with 99304-99318. Initial care codes are 99304-99306, and subsequent care codes are 99307-99310. There are also NF codes for discharge (99315-99316) and annual assessment services (99318).

Remember to use different place-of-service codes. CPT classifies rest home, domiciliary, and custodial care facilities as POS 33 (custodial care facility). For claims involving NF care, use POS 32 (nursing facility).

Locke, MD