Which CPT code is appropriate for an E/M nursing facility service involving an annual nursing facility assessment that requires a detailed interval history, a comprehensive examination, and medical decision making of low to moderate complexity?

Which CPT code is appropriate for an E/M nursing facility service involving an annual nursing facility assessment that requires a detailed interval history, a comprehensive examination, and medical decision making of low to moderate complexity?

• A. 99318
• B. 99213
• C. 99214
• D. 99457

Answer: (A)

Focusing on the setting and the level of service described, this scenario fits the annual nursing facility assessment for an established patient. When an on-site evaluation in a nursing facility requires a detailed interval history, a comprehensive examination, and medical decision making of low to moderate complexity, the appropriate CPT code is the nursing facility annual assessment code, typically reported as 60 minutes of face-to-face time. This code is specifically intended for annual assessments in long-term care facilities, distinguishing it from outpatient office visit codes, which are used for clinic settings and have different history, exam, and MDM thresholds. It’s also distinct from remote patient monitoring codes, which are for transmitting and managing data remotely and do not describe an on-site nursing facility evaluation. So, the code that best matches an annual nursing facility assessment with detailed history, comprehensive exam, and low-to-moderate MDM is the nursing facility annual assessment code.

Focusing on the setting and the level of service described, this scenario fits the annual nursing facility assessment for an established patient. When an on-site evaluation in a nursing facility requires a detailed interval history, a comprehensive examination, and medical decision making of low to moderate complexity, the appropriate CPT code is the nursing facility annual assessment code, typically reported as 60 minutes of face-to-face time.

This code is specifically intended for annual assessments in long-term care facilities, distinguishing it from outpatient office visit codes, which are used for clinic settings and have different history, exam, and MDM thresholds. It’s also distinct from remote patient monitoring codes, which are for transmitting and managing data remotely and do not describe an on-site nursing facility evaluation.

So, the code that best matches an annual nursing facility assessment with detailed history, comprehensive exam, and low-to-moderate MDM is the nursing facility annual assessment code.