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Auditing Physician Service


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Services in an assisted living facility
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According to the CPT® book, assisted living services are reported with codes 99324--99337. Look at that series of codes for new or established patients. It is not correct to bill at an assisted living facility with office visit codes. These codes are used for services provided in: domiciliary, rest home (eg, Boarding Home), or Custodial Care Services.  There are five new patient visits, which require 3 of 3 of the key components, and four established patient visits, which require 2 of 3 of the key components.


Place of service codes are in the front of the CPT® book, and assisted living is POS 13.  Other place of service codes are in the Medicare manual citation below, or in the CPT® book.

Here is a brief copy and paste from the Medicare Claims Processing Manual: Pub 100-04, Chapter 12, Section 30.6.14. You can download it at:

http://www.cms.hhs.gov/Manuals/IOM/list.asp

30.6.14 - Home Care and Domiciliary Care Visits (Codes 99324- 99350) (Rev. 775, Issued: 12-02-05, Effective: 01-01-06, Implementation: 01-03-06) Physician Visits to Patients Residing in Various Places of Service The American Medical Association’s Current Procedural Terminology (CPT) 2006 new patient codes 99324 – 99328 and established patient codes 99334 - 99337(new codes beginning January 2006), for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services, are used to report evaluation and management (E/M) services to residents residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. These CPT® codes are used to report E/M services in facilities assigned places of service (POS) codes 13 (Assisted Living Facility), 14 (Group Home), 33 (Custodial Care Facility) and 55 (Residential Substance Abuse Facility). Assisted living facilities may also be known as adult living facilities. Physicians and qualified nonphysician practitioners (NPPs) furnishing E/M services to residents in a living arrangement described by one of the POS listed above must use the level of service code in the CPT® code range 99324 – 99337 to report the service they provide. The CPT® codes 99321 – 99333 for Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services are deleted beginning January, 2006.

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