Question

Mr. Wallace was readmitted to the nursing home from the hospital. His doctor completed a required annual nursing facility assessment upon return to the nursing home. Mr. Wallace's doctor submitted code 99318 because of changes to the annual facility assessment. The code assignment is correct.

Answer 1

The use of code 99318 for Mr. Wallace's annual nursing facility assessment is likely correct if his doctor conducted a detailed evaluation in response to changes in Mr. Wallace's health following a hospital stay. Code 99318 represents in-depth assessments at nursing facilities. The accuracy of this code depends on the specific situation and adherence to CPT guidelines.

Step-by-step explanation:

Code 99318 is used for an annual nursing facility assessment. It applies when a physician completes an evaluation and management service for a patient residing in a nursing facility. This code reflects an extensive annual assessment encompassing a patient's health and physical condition. If Mr. Wallace's doctor completed an assessment that involved changes from the typical annual facility assessment, and these changes were significant enough to warrant a different level of care or a modified treatment plan, the use of 99318 might be justified. The code signifies that the physician conducted an individualized, detailed examination, potentially due to Mr. Wallace's hospitalization and changes in his health condition during that time.

To definitively determine the correctness of the code assignment, one would need to review the specific guidelines of the Current Procedural Terminology (CPT) used by medical professionals to report medical, surgical, and diagnostic procedures and services to entities such as health insurance companies and accreditation organizations. Only then can it be ascertained if the comprehensive assessment performed aligns with the prerequisites of code 99318.