Skilled nursing facilities (SNFs) are integral to healthcare, providing post-acute care, rehabilitation services, and long-term care for patients. Understanding the CPT (Current Procedural Terminology) codes used in these settings is crucial for accurate billing, reimbursement, and compliance with Medicare regulations.
In this article, we’ll explore the key CPT codes associated with skilled nursing facilities, the services they capture, and insights on effective documentation for maximizing reimbursements.
1. Introduction to Skilled Nursing Facility CPT Codes
Skilled nursing facilities are primarily used for patients who require ongoing care after hospital discharge. Billing for these services requires accurate use of CPT codes to ensure that facilities are reimbursed appropriately for the care provided. These codes vary depending on the type of service, from physical therapy to wound care.
2. Key Categories of CPT Codes for SNFs
Each service provided in a skilled nursing facility corresponds to a specific CPT code. The most commonly used categories include:
a) Therapy Services
Rehabilitation services such as physical, occupational, and speech therapy are among the most frequently billed services in skilled nursing facilities. Some common therapy-related CPT codes include:
- Physical Therapy:
- 97161: Physical therapy evaluation (low complexity)
- 97162: Physical therapy evaluation (moderate complexity)
- 97163: Physical therapy evaluation (high complexity)
- 97110: Therapeutic exercises
- Occupational Therapy:
- 97165: Occupational therapy evaluation (low complexity)
- 97166: Occupational therapy evaluation (moderate complexity)
- 97167: Occupational therapy evaluation (high complexity)
- Speech Therapy:
- 92521: Speech therapy evaluation
- 92522: Speech therapy evaluation with additional services
- 92507: Speech therapy treatment for speech/language disorders
These codes are dependent on the complexity of the therapy and the time spent on treatment.
b) Wound Care Procedures
Caring for chronic wounds is another key service in SNFs. Wound care requires meticulous coding to cover various aspects, such as debridement and the application of dressings. Important CPT codes include:
- 97597: Removal of devitalized tissue (debridement) from wounds
- 97605: Negative pressure wound therapy (first 50 square cm)
- 97606: Negative pressure wound therapy (each additional 50 square cm)
These codes often require accurate measurements and documentation of wound characteristics
c) Psychological and Psychiatric Services
SNFs provide mental health care, including psychological evaluations and therapy for conditions like depression and dementia. The CPT codes for these services include:
- 90832-90838: Psychotherapy codes based on time spent (30-60 minutes)
- 96116: Neurobehavioral status exam
- 96121: Neuropsychological testing
Proper use of these codes demands detailed documentation of the patient’s mental health needs, therapy sessions, and progress
d) Radiology and Diagnostic Codes
SNFs often conduct diagnostic tests like x-rays and lab work for patients. Common CPT codes for radiology services include:
- 71010: Chest X-ray (single view)
- 72100: Spine X-ray (multiple views)
For laboratory services, codes like 80048 (basic metabolic panel) and 80061 (lipid panel) are frequently used
e) Medication Administration
Administration of medications, particularly injections or IV therapies, is a routine task in SNFs. Codes that capture these services include:
- 96372: Injection of medication via subcutaneous or intramuscular route
- 96365: IV infusion of medication, initial hour
Accurate tracking of medications administered and the method of delivery is essential for correct billing
3. Modifiers in SNF Billing
Modifiers provide additional information about the service performed. Common modifiers in SNF therapy services include:
- GP: Services provided under a physical therapy plan
- GO: Services under an occupational therapy plan
- GN: Services under a speech therapy plan
These modifiers help to convey the context of the services provided and are essential for accurate billing and reimbursement
4. Best Practices for Documentation
To ensure correct reimbursement, skilled nursing facilities must maintain thorough documentation. Key details include:
- Patient diagnosis and medical necessity
- Time spent on each service
- Specific procedures performed
- Supplies and equipment used
- Ongoing evaluation notes
This robust documentation reduces the risk of claim denials and ensures that CPT codes used accurately reflect the services delivered.
5. Conclusion
Understanding and using the correct CPT codes is vital for skilled nursing facilities to optimize reimbursement and ensure compliance with healthcare regulations. Whether it’s rehabilitation services, wound care, or medication administration, accurate coding paired with detailed documentation is the key to successful billing.
By staying up-to-date with the latest codes and guidelines, skilled nursing facilities can streamline their billing processes and avoid common pitfalls in reimbursement.
