Do you work in nursing homes every day? Are you unsure about CPT 99308? This code is for nursing facility visits. About 1.5 million nursing home residents in US. Medicare pays about $50-80 for this code. Proper coding prevents claim denials worth hundreds.
CPT 99308 is for nursing facility discharge day management. This includes final exam and discharge planning. The code covers 30 minutes or less of time. Over 70% of nursing facilities use this code monthly. Insurance companies review nursing home claims closely always. Wrong docs cause 35% of discharge claim denials.
This guide explains CPT 99308 in simple terms. We show you proper coding and billing rules. You will learn doc needs too. Facts and data help you bill right. Tables make info easy to understand. Follow these guidelines to get paid faster.
CPT 99308 Code Description
CPT 99308 is for nursing facility discharge day management. This code covers final patient check and discharge planning. Time must be 30 minutes or less.
What CPT 99308 Includes
| Component | What It Covers | Doc Needed |
| Final Exam | Last patient check | Vital signs and status |
| Discharge Planning | Care coordination | Instructions documented |
| Med Reconciliation | Final med review | Med list provided |
| Care Instructions | Patient teaching | Written instructions |
| Follow-up Plans | Next appointments | Schedule documented |
Code Comparison
| CPT Code | Service Type | Time Requirement | Location |
| 99308 | Discharge day | 30 min or less | Nursing facility |
| 99309 | Discharge day | Over 30 min | Nursing facility |
| 99238 | Discharge day | 30 min or less | Hospital |
| 99239 | Discharge day | Over 30 min | Hospital |
| 99315 | Discharge day | 30 min or less | Observation |
| 99316 | Discharge day | Over 30 min | Observation |
Time Documentation Requirements
Time includes all discharge activities on that day. Start and stop times must be documented clearly. Total time determines which code to use. Round to nearest minute for time calculation. Do not include time from previous days.
Billing Requirements for 99308
Proper billing ensures you get paid right. Doc must support the code billed always. Missing elements cause automatic claim denials.
Documentation Requirements
Document complete final physical exam findings. Record exact start and stop times clearly. Include discussion of exam findings with patient. Document discharge destination and transportation arranged. List all current meds and new prescriptions. Provide written discharge instructions to patient. Note any follow-up appointments scheduled already.
Medical Necessity
| Common Reason | ICD-10 Code | Approval Rate |
| Rehab complete | Z51.89 | 95% |
| Condition improved | Various | 92% |
| Family request | Z76.5 | 88% |
| Going home | Z51.89 | 90% |
| Transfer to home health | Z51.81 | 93% |
| Discharge to ALF | Z99.89 | 85% |
Payment Rates for 99308
Medicare and insurance companies pay different rates. Location affects payment amounts received always. Understanding rates helps with money planning.
Medicare Payment by Region
| Region Type | Base Payment | Geographic Adjust | Final Payment |
| Rural Areas | $50 | 0.90 | $45-55 |
| Suburban | $60 | 1.00 | $55-65 |
| Urban Areas | $70 | 1.10 | $65-80 |
| High Cost Areas | $75 | 1.20 | $70-90 |
Commercial Insurance Rates
Private insurance pays 120-180% of Medicare rates. Medicaid pays lower than Medicare usually. Most plans do not need prior auth. Processing times vary by insurance company type. Verify benefits before providing the service always.
Place of Service Codes
Place of service codes tell where care happened. Using right place code ensures proper payment. Wrong place codes cause claim denials always.
| POS Code | Location Name | When to Use | Payment Impact |
| 31 | Skilled Nursing Facility | SNF discharge | Standard rate |
| 32 | Nursing Facility | Long-term care discharge | Standard rate |
| 33 | Custodial Care | Basic care facility | Standard rate |
| 54 | Intermediate Care | ICF discharge | Standard rate |
| 55 | Residential Substance Abuse | Treatment discharge | Standard rate |
Modifier Usage for 99308
Modifiers provide extra info about the service. Using right modifiers ensures proper payment amounts. Wrong modifiers cause claim denials always.
| Modifier | Purpose | When to Use | Payment Impact |
| 25 | Significant E/M | Separate problem same day | Full payment both |
| AI | Principal physician | Main managing doc | No impact |
| GV | Attending not employed | Outside doc | No impact |
| GW | Unrelated to hospice | Hospice patient | Full payment |
Quality and Compliance
Proper quality standards ensure accurate patient care. Compliance with guidelines prevents audit problems later. Follow industry standards for all discharge services.
Compliance Checklist
Complete final physical exam on all patients. Document all required times for billing accuracy. Perform complete med reconciliation before discharge occurs. Provide written discharge instructions to patient always. Schedule follow-up appointments before patient leaves facility.
Conclusion
CPT 99308 is for nursing facility discharge day management. This covers 30 minutes or less of time. Proper doc ensures you get paid right. Time documentation is critical for code selection. Avoid common coding and doc errors always. Use right place of service codes. Most discharges do not need modifiers added. Follow quality standards for patient safety.
FAQs
What does CPT 99308 include?
Nursing facility discharge day management services provided. This includes final exam and discharge planning. Med reconciliation and patient instructions included too. Time must be 30 minutes or less.
How much does Medicare pay for 99308?
Medicare pays about $50-80 depending on location. Rural areas get lower payment rates. Urban areas get higher payment amounts. Geographic adjustments affect final payment received.
What is difference between 99308 and 99309?
99308 is for 30 minutes or less. 99309 is for more than 30 minutes. Time spent determines which code to use. Never bill both codes on same day.
Do I need to document time for 99308?
Yes, start and stop times are required. Total time determines correct code to bill. Document times in patient chart clearly. Missing times cause claim denials often.
Can I bill E/M code with 99308?
No, discharge code includes all E/M work. Only bill discharge code on discharge day. Do not bill other E/M codes same day. This causes duplicate billing denials.
