Keys To Coding When You Are Seeing Patients In Nursing Facilities

The CPT codes 99304–99306 cover initial nursing facility care. Yes, podiatrists can absolutely submit initial nursing facility evaluation and management (E/M) codes for Medicare patients.


Medicare does not recognize consultation codes. When Medicare stopped recognizing consultation codes on January 1, 2010, it then instructed specialists, including podiatrists, to use the initial nursing facility codes when seeing a nursing facility patient for the first time during that patient’s admission. Podiatrists should use initial nursing facility codes if that encounter qualified for what the facility would consider a “consult” and even if the specialist was not the admitting/primary doctor. Since there are now multiple doctors using those initial encounter codes, the admitting/primary doctor must use an “AI” modifier on the initial E/M encounter.


This change did not alter the fact that in order to submit any E/M code, one must meet the thresholds of complexity for that code. Complexity refers to the key elements of E/M coding (history, exam, decision making) in what you performed, what you documented and what was medically necessary … read more