Correct Usage of 99336

Rest home care medical billing can be very tricky. Many coders bill for at home services or nursing home services when rest home care is performed. Incorrect medical billing coding such as this, could get you into trouble. Make sure your staff is up to date on the new medical billing coding regulations that addresses the specific guidelines for rest home coding.

The place of the service is a big issue when dealing with the rest home services. Rest home, or custodial care facility is labeled as a POS 33. This is defined as a facility that provides room, board and other personal assistance services generally on a long-term basis. There is a big medical billing difference between a rest home and a nursing home. Nursing homes include a medical component whereas a rest home does not.

Another change to medical billing coding for rest homes is the deletion of 99331-99333. Beginning in 2006, these medical billing codes were replaced by nine new rest home codes. The American Medical Association created these codes specifically to better understand the level of care given in these facilities. The new codes are fairly simple to understand. You will use the medical billing codes 99324-99337 fairly similarly to the way the outpatient visit codes 99221-99215 are used.

Just like doing medical billing for outpatient visits, three requirements must be met in order to satisfy certain levels of rest home care. However, established patients need only meet two out of three components. For example, since a patient is established, the physician would not need the problem focused history each and every time. You can still use the medical billing code 99336 in this case.

Although rest home facilities do not provide medical care, some diagnoses require custodial care. Make sure your staff is using the most current coding information or better yet, outsource your medical billing to the pros that make it their job to stay on top of the changes in the medical billing industry.

View all Articles by: Melissa Clark, CCS-P