How To Use CPT Code 99307

CPT 99307 is a code for subsequent nursing facility care involving evaluation and management with straightforward medical decision making. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99307.

1. What is CPT 99307?

CPT 99307 is a code used by medical professionals to bill for subsequent nursing facility care services. This code is specifically for the evaluation and management of a patient in a nursing facility setting, involving straightforward medical decision making or at least 10 minutes of total time spent on the encounter on a single date.

2. 99307 CPT code description

The official description of CPT code 99307 is: “Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.”

3. Procedure

The 99307 CPT code procedure involves the following steps:

1. Reviewing tests and preparing for the patient visit
2. Performing a medically appropriate history and/or examination
3. Evaluating the patient’s condition and determining the level of medical decision making required
4. Counseling and educating the patient or caregiver
5. Ordering tests and communicating with other healthcare providers
6. Documenting the encounter in the medical record
7. Interpreting and communicating test results
8. Coordinating care with other healthcare professionals or agencies

4. Qualifying circumstances

Patients eligible to receive CPT code 99307 services are those who are in a nursing facility setting and require evaluation and management services involving straightforward medical decision making or at least 10 minutes of total time spent on the encounter on a single date. The provider must determine the nature and extent of the history and/or examination required for the encounter.

5. When to use CPT code 99307

It is appropriate to bill the 99307 CPT code when a provider performs a subsequent nursing facility care visit involving evaluation and management services with straightforward medical decision making or at least 10 minutes of total time spent on the encounter on a single date. This code should not be used for initial nursing facility care visits or for visits that involve a higher level of medical decision making or more complex patient care.

6. Documentation requirements

To support a claim for CPT 99307, the following information must be documented in the patient’s medical record:

• Date of the encounter
• Total time spent on the encounter
• Medically appropriate history and/or examination performed
• Level of medical decision making involved
• Details of counseling and education provided to the patient or caregiver
• Tests ordered and results communicated
• Coordination of care with other healthcare professionals or agencies

7. Billing guidelines

When billing for CPT code 99307, it is important to follow coding and payer guidelines regarding the definition of a subsequent visit. Certain assessments performed before the initial comprehensive visit may require the use of subsequent care codes. Additionally, the E/M service level should be chosen based on the total time or MDM level stated in the code descriptor. All services performed must be documented appropriately in the medical record.

8. Historical information

CPT 99307 was added to the Current Procedural Terminology system on January 1, 2006. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2023.

9. Similar codes to CPT 99307

Five similar codes to CPT 99307 and how they differentiate are:

• CPT 99304: Initial nursing facility care with a comprehensive history and examination, and moderate medical decision making.
• CPT 99305: Initial nursing facility care with a comprehensive history and examination, and high medical decision making.
• CPT 99306: Initial nursing facility care with a comprehensive history and examination, and straightforward medical decision making.
• CPT 99308: Subsequent nursing facility care with a detailed history and examination, and moderate medical decision making.
• CPT 99309: Subsequent nursing facility care with a comprehensive history and examination, and high medical decision making.

10. Examples

Here are 10 detailed examples of CPT code 99307 procedures:

1. A patient with stable hypertension in a nursing facility requires a follow-up visit involving a review of their blood pressure readings and medication adjustments.
2. A patient recovering from a hip fracture in a nursing facility requires a subsequent visit to assess their pain management and mobility progress.
3. A patient with diabetes in a nursing facility requires a follow-up visit to review their blood glucose levels and adjust their insulin regimen.
4. A patient with congestive heart failure in a nursing facility requires a subsequent visit to monitor their fluid balance and adjust their diuretic medications.
5. A patient with a history of stroke in a nursing facility requires a follow-up visit to assess their neurological status and rehabilitation progress.
6. A patient with chronic obstructive pulmonary disease in a nursing facility requires a subsequent visit to evaluate their respiratory status and adjust their inhaler medications.
7. A patient with dementia in a nursing facility requires a follow-up visit to assess their cognitive function and discuss care planning with their caregiver.
8. A patient with a urinary tract infection in a nursing facility requires a subsequent visit to review their antibiotic treatment and assess their symptoms.
9. A patient with a pressure ulcer in a nursing facility requires a follow-up visit to evaluate the wound healing progress and adjust their wound care regimen.
10. A patient with a history of falls in a nursing facility requires a subsequent visit to assess their fall risk and discuss fall prevention strategies with their caregiver.