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Issue Number - Name
0056 - Evaluation and Management (E/M) Coding in Skilled Nursing Facilities
Review Type
Automated
Claim Type
All physician/NPP specialties
Region and State
RAC 1-4
All States
Date Approved
2017-08-01

Description

When evaluation and management (E/M) services are provided to patients in a Skilled Nursing Facility (SNF), CPT codes (99306,99309, 99310) should be reported. It is inappropriate to report hospital inpatient care codes (99223, 99232,99233) for SNF E/M services.

Affected Code(s)

  • 99223, 99232, 99233

Applicable Policy References

  • Title XVIII of the Social Security Act (SSA), Section 1833(e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.13
  • AMA CPT Manual, Evaluation and Management Section, Nursing Facility Services Guidelines