How To Use CPT Code 99309

CPT code 99309 has been designed for billing subsequent nursing facility care services. These services includes medical evaluation and management, which demands moderate level of medical decision making, or encompassing at least 30 minutes of total time dedicated to encounter. This article explores the workflow, meaning, and the appropriate circumstances for CPT 99309 usage, documentation requirements, applicable billing guidelines, and similar codes.

CPT 99309 is essentially a code that medical professionals apply for subsequent nursing facility care services. This specific code stands for the evaluation and management of a patient in a nursing facility setting, needing moderate medical decision making or a minimum of 30 minutes of total time spent on the encounter. The services offered under this code may contemplate taking a patient history, conducting a physical examination, and coordinating the care with other healthcare providers.

Description Of CPT Code 99309

The official explanation of the CPT code 99309 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 moderate extent of medical decision making. When employing total time on the date of the encounter for code selection, 30 minutes has to be met or exceeded.”

Any encounter under the code 99309 would follow a systematic procedure involving several steps, such as reviewing the patient’s medical history and relevant test results, conducting a medically appropriate physical examination, and coordinating care with other healthcare providers, if needed.

Patients who are based in a nursing facility and require evaluation and management services involving moderate medical decision making or at least 30 minutes of encounter total time are eligible for receiving code 99309 services. These patients can include those with ongoing complex medical conditions, those experiencing a significant change in their health status, or those needing continuous care coordination with other healthcare providers.

Exercising the 99309 CPT code becomes relevant when subsequent nursing facility care visit involving evaluation and management services with moderate medical decision making or a minimum of 30 minutes of total encounter time is performed by a provider. However, the code should not be used for initial nursing facility care visits, or for visits that do not meet the criteria for moderate medical decision making or the prescribed time threshold.

For effectively lodging a claim for CPT 99309, several factors should be documented such as a medically appropriate history and/or physical examination, the level of medical decision making involved in the encounter, and the total time spent on the encounter.

It is crucial to adhere to the coding and payer guidelines concerning the definition of a subsequent visit and the suitable use of this code when billing for CPT code 99309.

CPT 99309 entered into the Current Procedural Terminology system on January 1, 2006, and has been updated several times, with the latest change happening on January 1, 2023.

CPT 99304, 99305, 99307, 99308, and 99310 are amongst the codes similar to CPT 99309, with each one of them differentiating in terms of nursing facility settings and medical decision making levels.

The code 99309 applies to a variety of nursing care facility procedures, including continuous monitoring of a patient with congestive heart failure and adjustment of medications, and regular wound care and assessment of healing progress for a patient with diabetes and a recent foot ulcer.