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 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
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.
TMA Practice E-tips