11/30/2021

Billing for Patients Seen at a Nursing Home

If I see patients at a nursing home where the facility does the billing under their NPI, should my encounters have new patient codes OR are they existing patients. They are new patients to me. however, I am replacing another podiatrist. Let's say the patient now leaves the NH and sees me in office. Given that it's 2 different NPIs, should the initial visit be given a new patient e/m cpt or an existing patient cpt.

In a Nursing home facility Podiatrists can only bill established patient CPT codes 99307-99310 and use their own NPI. The providers that can bill for a new patient nursing home visit are PCP’s as they are usually the admitting providers.

If patient is seen in your office after, all encounters where an E&M service is provided, would be an established patient CPT, unless its 3 years later since you are billing under your own NPI.