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2010 Medicare Updates/Insurance News

I just received notice from FCSO that the SNF codes for initial visits 99304 - 99306 are officially open for podiatrists to use. Anyone holding claims for nursing home consultations should bill the initial visit codes. If you have previously billed, in 2010, 99034 and been denied you will need to resubmit or appeal.

Stephen Meritt, DPM
Medicare Liaison

  • Information About SNF Initial Visit Codes (1/27/10)

With the deletion of consultation codes, the rules have changed relative to the use of initial inpatient hospital and initial nursing facility codes. As in the inpatient hospital setting, the principal physician of record in the skilled nursing facility setting bills the initial visit code (99304-99306) and appends the AI modifier to identify himself/herself as the physician overseeing the patient's care. All other physicians, including podiatric physicians, report their initial visit to the patient with the initial visit code.

Section 30.6.13 A. of Chapter 12 in Pub. 100-04 (Medicare Claims Processing Manual) has been revised to state:

"The initial visit in a SNF and NF must be performed by the physician except as otherwise permitted (42 CFR 483.40 [c] [4]). The principal physician of record must append the modifier "-XX," Principal Physician of Record, to the initial nursing facility care code. This modifier will identify the physician who oversees the patient's care from other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation in the nursing facility may bill the initial nursing facility care code..."

ADDENDUM: First Coast Service Options is trying to open the SNF initial visit codes this week, but they may not be open for us yet. I would suggest that everyone hold SNF initial visit claims for 2 to 3 weeks and then submit them.

Stephen Meritt, DPM
Medicare Liaison

PDF Files:

Loc3.pdf
Loc4.pdf
Loc99.pdf

Text Files:

2010_FL03_MPFS.txt
2010_FL04_MPFS.txt
2010_FL99_MPFS.txt

 
 

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