How To Use CPT Code 99306

CPT 99306 refers to initial 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. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99306.

1. What is CPT 99306?

CPT 99306 is a medical billing code used to describe the initial nursing facility care provided to a patient on a per-day basis. This code is specifically used for evaluation and management services that require a medically appropriate history and/or examination and a high level of medical decision making. The code is applicable when the provider spends at least 45 minutes of total time on the encounter on a single date.

2. 99306 CPT code description

The official description of CPT code 99306 is: “Initial 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 99306 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
  7. Interpreting and communicating results
  8. Coordinating care with other healthcare professionals or agencies

4. Qualifying circumstances

Patients eligible to receive CPT code 99306 services are those who require initial nursing facility care, which involves evaluation and management services. These patients typically have complex medical conditions that necessitate a high level of medical decision making. The provider must spend at least 45 minutes of total time on the encounter on a single date for the code to be applicable.

5. When to use CPT code 99306

It is appropriate to bill the 99306 CPT code when a provider performs an initial nursing facility care visit involving evaluation and management services that require a medically appropriate history and/or examination and a high level of medical decision making. The code can be used when the provider spends at least 45 minutes of total time on the encounter on a single date.

6. Documentation requirements

To support a claim for CPT 99306, the following information must be documented:

  • Medically appropriate history and/or examination performed
  • High level of medical decision making involved
  • Total time spent on the encounter (at least 45 minutes)
  • 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
  • Any other relevant information related to the patient’s condition and treatment

7. Billing guidelines

When billing for CPT code 99306, it is essential to ensure that the documentation supports the claim and that the code is used appropriately. The provider must have spent at least 45 minutes of total time on the encounter on a single date, and the service must involve a high level of medical decision making. Additionally, all services performed should be documented appropriately in the medical record.

8. Historical information

CPT 99306 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 99306

Five similar codes to CPT 99306 include:

  • CPT 99304: Initial nursing facility care with a lower level of medical decision making
  • CPT 99305: Initial nursing facility care with a moderate level of medical decision making
  • CPT 99307: Subsequent nursing facility care with a low level of medical decision making
  • CPT 99308: Subsequent nursing facility care with a moderate level of medical decision making
  • CPT 99309: Subsequent nursing facility care with a high level of medical decision making

10. Examples

Here are 10 detailed examples of CPT code 99306 procedures:

  1. A patient with multiple chronic conditions is admitted to a nursing facility, requiring a comprehensive evaluation and management plan.
  2. A patient with a recent stroke is admitted to a nursing facility for rehabilitation and requires a high level of medical decision making.
  3. A patient with advanced dementia is admitted to a nursing facility, necessitating a thorough assessment and management plan.
  4. A patient with a complex wound is admitted to a nursing facility for wound care and requires a high level of medical decision making.
  5. A patient with a recent hip fracture is admitted to a nursing facility for postoperative care and rehabilitation, requiring a comprehensive evaluation and management plan.
  6. A patient with severe congestive heart failure is admitted to a nursing facility for close monitoring and management, necessitating a high level of medical decision making.
  7. A patient with advanced Parkinson’s disease is admitted to a nursing facility for assistance with activities of daily living and requires a comprehensive evaluation and management plan.
  8. A patient with a recent amputation is admitted to a nursing facility for prosthetic fitting and rehabilitation, requiring a high level of medical decision making.
  9. A patient with end-stage renal disease is admitted to a nursing facility for dialysis management and requires a comprehensive evaluation and management plan.
  10. A patient with a complicated postoperative course is admitted to a nursing facility for close monitoring and management, necessitating a high level of medical decision making.

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