How To Use CPT Code 99308

CPT 99308 is a code for subsequent nursing facility care involving evaluation and management with low medical decision making or at least 15 minutes of total time spent on the encounter. This article will cover topics such as the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 99308.

1. What is CPT 99308?

CPT 99308 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 a low level of medical decision making or at least 15 minutes of total time spent on the encounter. The code is used to ensure accurate billing and reimbursement for the services provided by healthcare professionals in this setting.

2. 99308 CPT code description

The official description of CPT code 99308 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 low level of medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.”

3. Procedure

The 99308 CPT code procedure involves the following steps:

1. Reviewing the patient’s medical history and/or performing a medically appropriate examination.
2. Evaluating the patient’s condition and determining the level of medical decision making required.
3. Spending at least 15 minutes on the encounter, including both face-to-face and non-face-to-face activities.
4. Documenting the encounter, including the history, examination, and medical decision making.
5. Coordinating care with other healthcare providers, if necessary.

4. Qualifying circumstances

Patients eligible to receive CPT code 99308 services are those who are in a nursing facility setting and require evaluation and management services. The patient’s condition must warrant a low level of medical decision making or at least 15 minutes of total time spent on the encounter. This code is not applicable for initial nursing facility care or comprehensive nursing facility care.

5. When to use CPT code 99308

It is appropriate to bill the 99308 CPT code when a healthcare provider performs a subsequent nursing facility care visit involving evaluation and management services for a patient in a nursing facility setting. The visit must involve a low level of medical decision making or at least 15 minutes of total time spent on the encounter. This code should not be used for initial nursing facility care or comprehensive nursing facility care.

6. Documentation requirements

To support a claim for CPT 99308, the following information must be documented:

• A medically appropriate history and/or examination performed by the provider.
• The level of medical decision making involved in the encounter.
• The total time spent on the encounter, including both face-to-face and non-face-to-face activities.
• Any coordination of care with other healthcare providers, if applicable.
• Details of the patient’s condition and the services provided during the encounter.

7. Billing guidelines

When billing for CPT code 99308, it is essential to follow coding and payer guidelines regarding the definition of a subsequent visit. Ensure that the E/M service level is based on the total time or MDM level stated in the code descriptor. Additionally, the services provided should be documented appropriately in the medical record to support the claim.

8. Historical information

CPT 99308 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 99308

Five similar codes to CPT 99308 and how they differentiate are:

• CPT 99304: Initial nursing facility care, which is used for the first visit in a nursing facility setting.
• CPT 99305: Initial nursing facility care with a comprehensive history and examination, and moderate medical decision making.
• CPT 99306: Initial nursing facility care with a comprehensive history and examination, and high medical decision making.
• CPT 99307: Subsequent nursing facility care with a problem-focused interval history and examination, and straightforward medical decision making.
• CPT 99309: Subsequent nursing facility care with a detailed interval history and examination, and moderate medical decision making.

10. Examples

Here are 10 detailed examples of CPT code 99308 procedures:

1. A patient with stable chronic obstructive pulmonary disease (COPD) requires a follow-up visit in the nursing facility, involving a review of their medical history, a brief examination, and low-level medical decision making.
2. A patient recovering from a stroke in a nursing facility requires a subsequent visit to evaluate their progress, involving a review of their medical history, a brief examination, and low-level medical decision making.
3. A patient with a urinary tract infection in a nursing facility requires a follow-up visit to assess their response to antibiotic treatment, involving a review of their medical history, a brief examination, and low-level medical decision making.
4. A patient with congestive heart failure in a nursing facility requires a subsequent visit to monitor their fluid status, involving a review of their medical history, a brief examination, and low-level medical decision making.
5. A patient with diabetes in a nursing facility requires a follow-up visit to evaluate their blood sugar control, involving a review of their medical history, a brief examination, and low-level medical decision making.
6. A patient with a pressure ulcer in a nursing facility requires a subsequent visit to assess the wound healing, involving a review of their medical history, a brief examination, and low-level medical decision making.
7. A patient with dementia in a nursing facility requires a follow-up visit to evaluate their cognitive status, involving a review of their medical history, a brief examination, and low-level medical decision making.
8. A patient with a recent hip fracture in a nursing facility requires a subsequent visit to monitor their pain management, involving a review of their medical history, a brief examination, and low-level medical decision making.
9. A patient with Parkinson’s disease in a nursing facility requires a follow-up visit to assess their response to medication adjustments, involving a review of their medical history, a brief examination, and low-level medical decision making.
10. A patient with a history of falls in a nursing facility requires a subsequent visit to evaluate their fall risk and implement preventive measures, involving a review of their medical history, a brief examination, and low-level medical decision making.