cpt 99309, cpt code 99309, 99309 cpt code

CPT Code 99309 | Subsequent Nursing Facility Care: E&M Of Patients

CPT code 99309 describes a medical service called “subsequent nursing facility care,” which involves evaluating and managing a patient in a nursing home setting, with a minimum time requirement of 30 minutes or a moderate level of medical decision-making.

What Is CPT Code 99309?

CPT 99309 describes a medical service called “subsequent nursing facility care,” which involves evaluating and managing a patient in a nursing home setting. This service includes a medically appropriate history and examination and a moderate level of medical decision-making.

To be eligible for CPT 99309, the provider must spend at least 30 minutes with the patient on the day of the encounter, or the medical decision-making must be moderate in complexity.

CPT code 99309 may include the following:

  • Reviewing tests.
  • Performing exams, counseling, and educating patients.
  • Ordering tests.
  • Communicating with other healthcare providers.

The level of medical decision-making is determined based on the number and complexity of problems being addressed, the amount and complexity of data to review and analyze, and the potential risks associated with managing the patient’s care.

Description

The CPT book describes CPT code 99309 as: “Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.”

Procedure

The provider performs an evaluation and management (E/M) service for a patient in the nursing facility. This is a subsequent service.

The total time spent on the encounter date is at least 30 minutes, or the level of medical decision-making (MDM) involved is moderate.

Total time includes both face–to–face and non–face–to–face activities on the encounter date.

Examples include, but are not limited to, reviewing tests and preparing for the patient visit, performing the exam or evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care.

Elements of MDM include:

  • The number and complexity of problems addressed.
  • The amount and/or complexity of data to review and analyze.
  • The risk of complications, morbidity, and mortality related to patient management. 

How To Use CPT 99309

CPT code 99309 can also include taking a patient history and performing a physical examination. The provider determines the nature and extent of the history and/or exam appropriate for the encounter.

Check coding and payer guidelines regarding the definition of a subsequent visit. For instance, specific assessments performed before the initial comprehensive visit may require using subsequent care codes. 

Choose the E/M service level based on the total time or MDM level stated in the code descriptor. 

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