Coding for Consultations at Nursing Homes

Q  I am often asked to consult on patients at a nursing home near my medical practice. How should I code for this service - as an inpatient or outpatient consultation?

A  A nursing home is considered an outpatient facility for billing consultations. Use an outpatient consultation code - 99241 through 99245 - if a consultation occurs in your office, a hospital clinic, an observation room, the patient's home, a facility providing domiciliary or custodial services, a nursing home, or an emergency room.

Use an inpatient consultation code - 99251 through 99263 - if the place of service for your consultation is an inpatient hospital, a resident nursing facility, or partial hospital setting that provides direct medical services.

Watch your place-of-service (POS) codes when filing claims. You must pair POS codes for skilled nursing facilities (POS code 31), nursing facilities (POS code 32), and intermediate care facilities (POS code 54) with an inpatient consultation code. A regular nursing home is considered a custodial facility (POS code 33) and takes an outpatient consultation code.

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