How To Use CPT Code 99310

CPT 99310 is a code for subsequent nursing facility care involving evaluation and management with high medical decision making or at least 45 minutes of total time spent on the encounter. This article will cover topics such as the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99310 procedures.

1. What is CPT 99310?

CPT 99310 is a code used by medical professionals to bill for subsequent nursing facility care services. These services involve evaluation and management of a patient, requiring a high level of medical decision making or at least 45 minutes of total time spent on the encounter. The code is used to accurately document and bill for the services provided during a subsequent nursing facility care visit.

2. 99310 CPT code description

The official description of CPT code 99310 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 high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.”

3. Procedure

The 99310 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 45 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 99310 services are those who require subsequent nursing facility care. This includes patients who have already had an initial nursing facility care visit and require further evaluation and management. The patient’s condition must warrant a high level of medical decision making or at least 45 minutes of total time spent on the encounter.

5. When to use CPT code 99310

It is appropriate to bill the 99310 CPT code when a provider performs a subsequent nursing facility care visit involving evaluation and management of a patient, requiring a high level of medical decision making or at least 45 minutes of total time spent on the encounter. This code should not be used for initial nursing facility care visits or for visits that do not meet the required level of medical decision making or total time spent on the encounter.

6. Documentation requirements

To support a claim for CPT 99310, the following information must be documented:

• A medically appropriate history and/or examination performed during the encounter.
• The level of medical decision making required for the patient’s condition.
• 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.
• A detailed record of the encounter, including the history, examination, and medical decision making.

7. Billing guidelines

When billing for CPT code 99310, it is important to follow coding and payer guidelines regarding the definition of a subsequent visit. Ensure that the E/M service level is chosen based on the total time or medical decision making level stated in the code descriptor. Additionally, document all services performed during the encounter, including a medically appropriate history and/or physical examination, as required by the provider.

8. Historical information

CPT 99310 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 99310

Five similar codes to CPT 99310 and how they differentiate are:

• CPT 99304: Initial nursing facility care visit with a detailed history, detailed examination, and straightforward medical decision making.
• CPT 99305: Initial nursing facility care visit with a comprehensive history, comprehensive examination, and moderate medical decision making.
• CPT 99307: Subsequent nursing facility care visit with a problem-focused history, problem-focused examination, and straightforward medical decision making.
• CPT 99308: Subsequent nursing facility care visit with an expanded problem-focused history, expanded problem-focused examination, and moderate medical decision making.
• CPT 99309: Subsequent nursing facility care visit with a detailed history, detailed examination, and high medical decision making, but with a lower total time requirement than CPT 99310.

10. Examples

Here are 10 detailed examples of CPT code 99310 procedures:

1. A patient with a history of congestive heart failure requires a subsequent nursing facility care visit to evaluate their condition and adjust their medication regimen, requiring high medical decision making and 50 minutes of total time spent on the encounter.
2. A patient with advanced dementia requires a subsequent nursing facility care visit to assess their cognitive decline and coordinate care with a neurologist, requiring high medical decision making and 45 minutes of total time spent on the encounter.
3. A patient with a recent stroke requires a subsequent nursing facility care visit to evaluate their progress and determine the need for additional rehabilitation services, requiring high medical decision making and 60 minutes of total time spent on the encounter.
4. A patient with uncontrolled diabetes requires a subsequent nursing facility care visit to adjust their insulin regimen and provide education on blood glucose monitoring, requiring high medical decision making and 55 minutes of total time spent on the encounter.
5. A patient with a complicated wound infection requires a subsequent nursing facility care visit to assess the wound, adjust antibiotic therapy, and coordinate care with a wound care specialist, requiring high medical decision making and 48 minutes of total time spent on the encounter.
6. A patient with a history of chronic obstructive pulmonary disease requires a subsequent nursing facility care visit to evaluate their respiratory status and adjust their treatment plan, requiring high medical decision making and 50 minutes of total time spent on the encounter.
7. A patient with a recent hip fracture requires a subsequent nursing facility care visit to assess their pain management and coordinate care with an orthopedic surgeon, requiring high medical decision making and 45 minutes of total time spent on the encounter.
8. A patient with end-stage renal disease requires a subsequent nursing facility care visit to evaluate their overall condition and coordinate care with a nephrologist, requiring high medical decision making and 52 minutes of total time spent on the encounter.
9. A patient with a history of severe depression requires a subsequent nursing facility care visit to assess their mental health status and adjust their medication regimen, requiring high medical decision making and 47 minutes of total time spent on the encounter.
10. A patient with a complicated urinary tract infection requires a subsequent nursing facility care visit to evaluate their response to antibiotic therapy and coordinate care with a urologist, requiring high medical decision making and 46 minutes of total time spent on the encounter.