Code Those Nursing Home Visits Correctly

Code Those Nursing Home Visits Correctly

Places of service have brought on many headaches when medically billing claims. The place of service, nursing home, is probably the most confusing location. There are certain guidelines when medically billing to ensure nursing home locations are coded correctly.

The biggest question that comes up when dealing with nursing homes is whether it should be coded as an outpatient facility or inpatient facility when medically billing for consultations. The codes 99241 through 99245 are outpatient consultation codes reserved for the following locations: office, hospital clinic, facility providing custodial services, emergency room, observation room in the hospital, home, or nursing home. The codes 99251 through 99263 are reserved for inpatient locations only. These would include inpatient hospital stays and skilled nursing facilities. As you can see, nursing homes are considered outpatient facilities, so they would be given outpatient consultation CPT codes for medical billing.

Place-of-service codes are also important when doing medical billing. The place-of-service code must match the CPT code. An outpatient place-of-service code must be medically billed with an outpatient CPT code. Likewise, an inpatient place-of-service code must be medically billed with an inpatient CPT code. The place-of-service code for a nursing home is 33 in medical billing. It is considered a custodial facility.

If the place-of-service code does not match with the CPT code given, the claim may not be paid. In order to insure correct medical billing practices with places-of-service, it is important to hire a medical billing company.

It may seem simple now to bill a nursing home as an outpatient facility, but there are other locations that are more confusing. By outsourcing your medical billing, you will insure correct coding on all your future claims. Outsourcing medical billing will save you time and money.

View all Articles by: Melissa C. - OMG, LLC. CEO