HCH Care Coordination Measures:
Follow-up After Hospital Discharge
Description
Percentage of patients with selected clinical conditions that have a follow-up telephonic/ electronic
contact within three days of discharge OR a follow-up face-to-face visit with a health care provider
(physician, physician assistant, nurse practitioner, nurse, care-coordinator) within seven days of
hospital discharge.
1
Clinical conditions represent those with the highest volume of readmissions in MN and include:
•
•
•
•
Heart failure
Pneumonia
Ischemic vascular disease
Chronic obstructive pulmonary disease
Methodology
Population identification is accomplished via a query of a practice management system or Electronic
Medical Record (EMR) to identify the population of eligible patients (denominator). Data elements
are either extracted from an EMR system or abstracted through medical record review.
Rationale
Benefits of improved care coordination include the reduction of potential harm from medication
2
errors, transitions, and poor communication.
Rehospitalization—patient admission to a hospital soon after discharge—is both common and costly.
In the majority of situations, hospitalization is necessary and appropriate. However, nearly one in
every five elderly patients who are discharged from the hospital is rehospitalized within 30 days.
Many of these rehospitalizations are avoidable, and thus suggest a failure in the systems of
3
establishing patients stably and safely in a new setting of care.
A study of over 12 million Medicare fee for service patients discharged in 2003 and 2004, found that
19.6% were readmitted to the hospital within 30 days, and cumulatively 34.0% in 90 days and 56.1%
in one year. For 50% of patients readmitted within 30 days, there was no bill for a physician visit
4
during that time.
Improving transitions of care through better coordination between hospitals and primary care
providers represents a way to help reduce the risks patient’s face when being discharged from the
hospital. Recent studies support this theory, Hernandez and colleagues found that among patients
being discharged after heart failure those who had an early outpatient follow-up were less likely to
5
be readmitted to the hospital within 30 days. Another study found that patients lacking follow-up
with a primary care physician within four weeks of discharge from the University of Colorado hospital
6
were 10 times more likely to be readmitted.
Improving communication and coordination between hospitals, patients, and primary care providers
represents a new approach aimed at reducing health care costs and a patient’s risk of experiencing
1
MN Hospital Association Potentially Preventable Readmission (3M Software) Data for 2011
Coleman EA, Parry C, Chalmers S, et.al. The Care Transitions Intervention: Results of a randomized controlled trial. Arch Intern Med;
166:1822-1828, 2006.
3
Effective Interventions to Reduce Rehospitalizations: A Survey of the Published Evidence. Cambridge, MA: Institute for Healthcare
Improvement; Boutwell, A. Hwu, S. 2009
4
Rehospitalizations Among Patients in the Medicare Fee-for-Service Program S. Jencks, M.Williams, E. Coleman NEJM April 2009
5
Relationship Between Early Physician Follow-up and 30 day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure.
Hernandez AF, Greiner, MA et.al. JAMA 2010;303(17):1716-1722
6 Post-Hospitalization Transitions: Examining the Effects of Timing of Primary Care Provider Follow-up Misky, GJ, Wald, HL, Coleman EA
Journal of Hospital Medicine September 2010
2
complications after a hospital discharge.
The Hospital to Home initiative co-sponsored by the American College of Cardiology and the Institute
for Healthcare Improvement calls for a 7 day follow-up visit after discharge for individuals
hospitalized with cardiovascular disease. Additionally, groups participating in the CMS sponsored
Physician Group Practice Demonstration aimed for a post-hospital follow-up appointment to occur
within five days for high-risk patients.
Alignment with goals of the RARE Reducing Avoidable Readmissions Effectively campaign in
Minnesota (Link to RARE Project - Preventing Readmissions) also an important determinate for the
selection of this measure and a perfect fit for the goal improving care coordination for patients.
Additionally, the Minnesota Department of Health’s Health Care Home program establishes a
standard that certified clinic engage their patients in planning for transitions of care. Minnesota’s
Health Care Home certification requires under Care Coordination subpart 5E requires that clinics
must have processes in place timely post discharge planning according to a protocol for patients
discharged from hospitals, skilled nursing facilities or other health care institutions.
Measurement Period
Measurement period will be a fixed 12 month period: mm/dd/yyyy to mm/dd/yyyy.
Patient
Population
Follow-up Face to
Face Visit after
Discharge
Established patient who meets each of the following criteria is included in the population:
Measure
Follow-up Visit Seven
Days after Discharge

Patients age 18 and older at the start of the measurement period (date of birth was on or
less than mm/dd/yyyy) AND

Has one or more of the following diagnoses: heart failure, pneumonia, ischemic vascular
disease or COPD. Please see tables below for diagnosis codes. Diagnosis codes in either the
principle or secondary diagnosis position OR diagnosis is active on the problem list AND

Hospitalized with an inpatient discharge date within the measurement year AND

Meets the following established patient criteria:
o
Patient was seen by an eligible provider in an eligible specialty face-to-face at least
two times during the last two years (mm/dd/yyyy to mm/dd/yyyy) for any reason
by a certified health care home clinic.
o
Patient was seen by an eligible provider in an eligible specialty face-to-face at least
one time during the last 12 months (mm/dd/yyyy to mm/dd/yyyy) for any reason
by a certified health care home clinic.
Percentage of established patients 18 and older with selected diagnoses that have a either a
telephonic or electronic contact within three days of discharge or a face-to-face visit within seven
days of hospital inpatient discharge. Electronic contacts include email contact with patient reply,
patient portal contact with reply and e-Visits. Face-to-face visits include all of the following visit
types: office, long term care/ assisted living, home care visits, visits with a specialist, or visit with a
care coordinator or nurse.
# of patients age 18 & older with select diagnoses and either a telephonic or electronic contact within
3 days OR a follow-up visit within 7 days of discharge
# patients age 18 & older with selected diagnoses and hospital discharge in measurement period
Eligible Providers,
Specialties and Clinics
Eligible Clinics: Certified Health Care Home Clinic
Eligible specialties: Family Medicine (Includes General Practice), Internal Medicine, and Geriatric
Medicine.
Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Nurse
Practitioner (NP)
Please note: Eligible providers and specialties are used for determining the visit counts for
established patient criteria, which serve to determine if a patient “belongs” to this clinic. It does not
mean that there is a requirement for the follow-up contact/ visit to occur with the above listed
provider types.
Allowable Exclusions
Additional Measures
for Analysis/Quality
Improvement
Exclusions include patients with an in-hospital death, transfer to an acute or long term care facility, or
outpatient/ observation status.
•
•
Patient died during hospital stay
Patient was transferred from a hospital discharge to another acute care facility
•
The average number of days between discharge date and follow-up contact/ visit stratified by
telephonic/ electronic and face-to-face
The average number of days between the discharge date and the date clinic was notified of
discharge
Rate of patient follow-up telephonic or electronic contact within three days of hospital discharge
Rate of patient follow-up face to face visit within seven days of hospital discharge
•
•
•
Additional
Considerations
During the evolution of this measure, rather than limiting or requiring the face-to-face visit to be with
a physician (or doctor of osteopathy, physician assistant , or nurse practitioner), the group, from an
economical and team care approach, desired the inclusion of other types of face-to-face visits with
the patient. Following public comment period for this measure, the development work group redesigned the original face-to-face visit measure to incorporate telephonic and electronic contacts, to
allow for cost effective delivery of care. Though the content of the visit is not included as part of the
measure, it is recognized that the type of activities that occur during this follow-up visit, particularity
medication reconciliation and patient engagement, are recognized as key for avoiding readmission to
7,8
the hospital. See next section on guidance for follow-up visits/contacts.
During the measure development process there was passion for including conditions applicable to
pediatrics patients, however the relative low volume of pediatric readmissions state-wide according
to the MN Hospital Association’s data did not support data collection efforts (impact and burden).
Additional Guidance:
Expectations for
Content of Follow-up
Contact/ Visit Post
6
Hospital Discharge
Suggested content for a follow-up contact or visit*:











Patient’s goals for the visit
Factors contributing to admission
Medication patient is taking and on what schedule
Medication reconciliation
Need for medication adjustment
Explanation of warning signs and how to respond + Teach Back
Needs for instruction on self-management + Teach Back
Instructions for seeking emergency and non-emergency care
Follow-up on test results
Monitoring and testing
Advanced care planning
* As appropriate for patient’s diagnosis
RARE Reducing Avoidable Readmissions Effectively Link to RARE Project - Preventing Readmissions RARE Campaign
Minnesota
8
Coleman, Eric The Post Hospital Follow-up Visit- California Health Care Brief
7
Diagnosis Codes for Inclusion
Diagnosis codes in either the principle or secondary diagnosis position OR diagnosis is active on the problem list. If the
patient has one or more of these codes and discharged from the hospital during the measurement year, they are to be
included in the denominator.
Heart Failure
Code
Heart Failure ICD-9 Code Descriptions
402.01
Hypertensive heart disease, malignant, with heart failure
402.11
Hypertensive heart disease, benign, with heart failure
402.91
Hypertensive heart disease, unspecified, with heart failure
404.01
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney
disease stage I through stage IV, or unspecified
404.03
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney
disease stage V or end stage renal disease
404.11
Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease
stage I through stage IV, or unspecified
404.13
Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage
V or end stage renal disease
404.91
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney
disease stage I through stage IV, or unspecified
404.93
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease
stage V or end stage renal disease
428.0
Congestive heart failure, unspecified
428.1
Left heart failure
428.20
Unspecified systolic heart failure
428.21
Acute systolic heart failure
428.22
Chronic systolic heart failure
428.23
Acute on chronic systolic heart failure
428.30
Unspecified diastolic heart failure
428.31
Acute diastolic heart failure
428.32
Chronic diastolic heart failure
428.33
Acute on chronic diastolic heart failure
428.40
Unspecified combined systolic and diastolic heart failure
428.41
Acute combined systolic and diastolic heart failure
428.42
Chronic combined systolic and diastolic heart failure
428.43
Acute on chronic combined systolic and diastolic heart failure
428.9
Heart failure, unspecified
Pneumonia
Code
Pneumonia ICD-9 Code Descriptions
480.0
Pneumonia due to adenovirus
480.1
Pneumonia due to respiratory syncytial virus
480.2
Pneumonia due to parainfluenza virus
480.3
Pneumonia due to SARS associated coronavirus
480.8
Viral pneumonia: pneumonia due to other virus not elsewhere classified
480.9
Viral pneumonia unspecified
481
Pneumococcal pneumonia [streptococcus pneumoniae pneumonia]
482.0
Pneumonia due to klebsiella pneumoniae
482.1
Pneumonia due to pseudomonas
482.2
Pneumonia due to hemophilus influenzae (h. influenzae)
482.30
Pneumonia due to streptococcus unspecified
482.31
Pneumonia due to streptococcus group a
482.32
Pneumonia due to streptococcus group b
482.39
Pneumonia due to other streptococcus
482.40
Pneumonia due to staphylococcus unspecified
482.41
Methicillin susceptible pneumonia due to staphylococcus aureus
482.42
Methicillin resistant pneumonia due to staphylococcus aureus
482.49
Other staphylococcus pneumonia
482.81
Pneumonia due to anaerobes
482.82
Pneumonia due to escherichia coli [e.coli]
482.83
Pneumonia due to other gram negative bacteria
482.84
Pneumonia due to legionnaires' disease
482.89
Pneumonia due to other specified bacteria
482.9
Bacterial pneumonia unspecified
483.0
Pneumonia due to mycoplasma pneumoniae
483.1
Pneumonia due to chlamydia
483.8
Pneumonia due to other specified organism
485
Bronchopneumonia organism unspecified
486
Pneumonia organism unspecified
487.0
Influenza with pneumonia
Ischemic Vascular Disease
Code
Ischemic Vascular Disease ICD-9 Code Descriptions
410.00
AMI ANTEROLATERAL,UNSPEC
410.01
AMI ANTEROLATERAL, INITIAL
410.02
AMI ANTEROLATERAL,SUBSEQ
Code
Ischemic Vascular Disease ICD-9 Code Descriptions
410.10
AMI ANTERIOR WALL,UNSPEC
410.11
AMI ANTERIOR WALL, INITIAL
410.12
AMI ANTERIOR WALL,SUBSEQ
410.20
AMI INFEROLATERAL,UNSPEC
410.21
AMI INFEROLATERAL, INITIAL
410.22
AMI INFEROLATERAL,SUBSEQ
410.30
AMI INFEROPOST, UNSPEC
410.31
AMI INFEROPOST, INITIAL
410.32
AMI INFEROPOST, SUBSEQ
410.40
AMI INFERIOR WALL,UNSPEC
410.41
AMI INFERIOR WALL, INITIAL
410.42
AMI INFERIOR WALL,SUBSEQ
410.50
AMI LATERAL NEC, UNSPEC
410.51
AMI LATERAL NEC, INITIAL
410.52
AMI LATERAL NEC, SUBSEQ
410.60
TRUE POST INFARCT,UNSPEC
410.61
TRUE POST INFARCT, INITIAL
410.62
TRUE POST INFARCT,SUBSEQ
410.70
SUBENDO INFARCT, UNSPEC
410.71
SUBENDO INFARCT, INITIAL
410.72
SUBENDO INFARCT, SUBSEQ
410.80
AMI NEC, UNSPECIFIED
410.81
AMI NEC, INITIAL
410.82
AMI NEC, SUBSEQUENT
410.90
AMI NOS, UNSPECIFIED
410.91
AMI NOS, INITIAL
410.92
AMI NOS, SUBSEQUENT
411.0
POST MI SYNDROME
411.1
INTERMED CORONARY SYND
411.81
ACUTE COR OCCLSN W/O MI
411.89
AC ISCHEMIC HRT DIS NEC
412
OLD MYOCARDIAL INFARCT
413.0
ANGINA DECUBITUS
413.1
PRINZMETAL ANGINA
413.9
ANGINA PECTORIS NEC/NOS
414.00
COR ATH UNSP VSL NTV/GFT
414.01
CRNRY ATHRSCL NATVE VSSL
414.02
CRN ATH ATLG VN BPS GRFT
414.03
CRN ATH NONATLG BLG GRFT
Code
Ischemic Vascular Disease ICD-9 Code Descriptions
414.04
COR ATH ARTRY BYPAS GRFT
414.05
COR ATH BYPASS GRAFT NOS
414.06
COR ATH NATV ART TP HRT
414.07
COR ATH BPS GRAFT TP HRT
414.2
CHR TOT OCCLUS COR ARTRY
414.3
COR ATH DUE TO LIPID RICH PLAQUE
414.8
CHR ISCHEMIC HRT DIS NEC
414.9
CHR ISCHEMIC HRT DIS NOS
429.2
ASCVD
433.00
OCL BSLR ART WO INFRCT
433.01
OCL BSLR ART W INFRCT
433.10
OCL CRTD ART WO INFRCT
433.11
OCL CRTD ART W INFRCT
433.20
OCL VRTB ART WO INFRCT
433.21
OCL VRTB ART W INFRCT
433.30
OCL MLT BI ART WO INFRCT
433.31
OCL MLT BI ART W INFRCT
433.80
OCL SPCF ART WO INFRCT
433.81
OCL SPCF ART W INFRCT
433.90
OCL ART NOS WO INFRCT
433.91
OCL ART NOS W INFRCT
434.00
CRBL THRMBS WO INFRCT
434.01
CRBL THRMBS W INFRCT
434.10
CRBL EMBLSM WO INFRCT
434.11
CRBL EMBLSM W INFRCT
434.90
CRBL ART OC NOS WO INFRC
434.91
CRBL ART OCL NOS W INFRC
440.0
ATHERSCLEROSIS OF AORTA
440.1
RENAL ARTERY ATHEROSCLER
440.20
ATHSCL EXTRM NTV ART NOS
440.21
ATH EXT NTV AT W CLAUDCT
440.22
ATH EXT NTV AT W RST PN
440.23
ATH EXT NTV ART ULCRTION
440.24
ATH EXT NTV ART GNGRENE
440.29
ATHRSC EXTRM NTV ART OTH
440.4
CHR TOT OCCL ART EXTREM
444.0
ABD AORTIC EMBOLISM
444.01
SADDLE EMBOLUS OF ABDOMINAL AORTA
444.09
OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA
Code
Ischemic Vascular Disease ICD-9 Code Descriptions
444.1
THORACIC AORTIC EMBOLISM
444.21
UPPER EXTREMITY EMBOLISM
444.22
LOWER EXTREMITY EMBOLISM
444.81
ILIAC ARTERY EMBOLISM
444.89
ARTERIAL EMBOLISM NEC
444.9
ARTERIAL EMBOLISM NOS
445.01
ATHEROEMBOLISM,UPPER EXT
445.02
ATHEROEMBOLISM,LOWER EXT
445.81
ATHEROEMBOLISM, KIDNEY
445.89
ATHEROEMBOLISM, SITE NEC
Chronic Obstructive Pulmonary Disease
Code
Chronic Obstructive Pulmonary Disease ICD-9 Code Descriptions
491.20
Obstructive chronic bronchitis without exacerbation
491.21
Obstructive chronic bronchitis with acute exacerbation
491.22
Obstructive chronic bronchitis with acute bronchitis
491.8
Other chronic bronchitis
491.9
Unspecified chronic bronchitis
492.0
Emphysematous bleb
492.8
Other emphysema
493.20
Chronic obstructive asthma, unspecified
493.21
Chronic obstructive asthma, with status asthmaticus
493.22
Chronic obstructive asthma, with (acute) exacerbation
496
Chronic: nonspecific lung disease
Guidance for Established Patient Criteria Face-to-Face Visits for Denominator
For this measure, there are two different applications of the term “visit”. The first application is to determine if a patient
is established (belongs) and is to be included in the denominator. This involves a process of counting visits of a certain
type called an eligible provider. Eligible provider for the purpose of counting face-to-face visits to establish that patient to
a clinic or medical groups include all of the following  Medical Doctor (MD), Doctor of Osteopathy (DO), Physician
Assistant (PA), and Nurse Practitioner (NP).

Meets the following established patient criteria:
o
Patient was seen by an eligible provider in an eligible specialty face-to-face at least two times during the
last two years (mm/dd/yyyy to mm/dd/yyyy) for any reason by a certified health care home clinic.
o
Patient was seen by an eligible provider in an eligible specialty face-to-face at least one time during the
last 12 months (mm/dd/yyyy to mm/dd/yyyy) for any reason by a certified health care home clinic.
Groups can either use their EMR’s classification of visits or CPT codes to assist them in counting visits to determine
established patient criteria.
Electronic Medical Record Visit Types:
If you are going to use visit/ encounter types within an EMR to count face-to-face visits for meeting the established
patient criteria, the types of visits you would include are: office visit, annual exam, preventive care visit.
Do not include: lab only, nurse only, telephone, urgent care, email or patient portal contact.
Evaluation and Management (E & M) CPT Codes
The following list of codes may be helpful in determining what types of visits to include for identifying the patient
population (denominator). E & M codes do not need to be used when querying a practice management system to
determine visit counts; however, they have been included here to help further define what is meant by a “face-to-face”
visit with a provider. Please refer to a CPT coding manual for more details.
Description
CPT Codes
E & M Codes
Preventive Codes
Office Consultation
Individual Counseling
Group Counseling
Other Preventive Medicine Services
Unlisted E & M Codes
99201 – 99205, 99211 – 99215
99384- 99397
99241-99245
99401-99404
99411-99412
99420, 99429
99499
The second type of application for visits in this measure relates to the numerator, whose criteria are broader, including
non-face to-face contacts as well.
Telephonic, Electronic and Face-to-Face Contacts for Numerator
Types of visits that are included in the numerator, that is they count as either a telephonic for electronic contact with
interaction with the patient (not simply a message pushed out) or a face to face visit with the patient following hospital
discharge, include any of the flowing types of visits:
• Office visit with primary care provider
• Office visit or consultation with a specialist
• Office visit with care coordinator or nurse
• Home care visit
• Visit at a long-term care/ assisted living facility
• Telephone contact with patient reply
• Email contact with patient reply
• Patient portal contact with patient reply
• E-Visit with patient
Groups may use classifications of visits types stored within their EMR to classify these types of visits, many of which may
not be available within standardized billing and coding systems. CPT codes are included for guidance, but they are not allinclusive of the types of face-to-face visits acceptable for the numerator. Visit types submitted will be reviewed during
the validation audit.
CPT Codes [For guidance only]
CPT
CPT Description
Office Visits
99201
Office or other outpatient visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are self-limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or
family.
99202
Office or other outpatient visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient
and/or family.
99203
Office or other outpatient visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or
family.
99204
Office or other outpatient visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient
and/or family.
99205
Office or other outpatient visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient
and/or family.
99211
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the
presenting problem(s) are self-limited or minor. Physicians or other qualified health care provider typically 5
minutes are spent performing or supervising these services.
99212
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the
presenting problem(s) are self-limited or minor. Physicians typically spend 10 minutes face-to-face with the patient
and/or family
99213
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the
presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the
patient and/or family.
99214
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the
presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the
patient and/or family.
99215
Office or other outpatient visit for the evaluation and management of an established patient. Usually, the
presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the
patient and/or family.
Telephonic and Electronic Contacts
99441
Telephone evaluation and management services by a physician or other qualified health care professional who may
report E&M services provided to an established patient, parent or guardian. 5 to 10 minutes.
99422
Telephone evaluation and management services by a physician or other qualified health care professional who may
report E&M services provided to an established patient, parent or guardian. 11 to 20 minutes.
99423
Telephone evaluation and management services by a physician or other qualified health care professional who may
report E&M services provided to an established patient, parent or guardian. 21 to 30 minutes.
99444
Online evaluation and management services by a physician or other qualified health care professional who may
report E&M services provided to an established patient, parent or guardian.
Transitional Care Management Services
Caution: These codes provide first step in understanding that a contact and a visit occurred for the patient but need to also
include the dates of each contact to allow calculation of numerator
99495
Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of
CPT
CPT Description
discharge, medical decision making moderate complexity and face to face within 14 calendar days
99496
Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of
discharge, medical decision making high complexity and face to face within 7 calendar days
Long Term Care/ Assisted Living
99304
Initial nursing facility care, per day, for the evaluation and management of a patient. Usually the problem(s)
requiring admission are of low severity. Physicians typically spend 25 minutes at the bedside and on the patient’s
floor or unit.
99305
Initial nursing facility care, per day, for the evaluation and management of a patient. Usually the problem(s)
requiring admission are of moderate severity. Physicians typically spend 35 minutes at the bedside and on the
patient’s floor or unit.
99306
Initial nursing facility care, per day, for the evaluation and management of a patient. Usually the problem(s)
requiring admission are of high severity. Physicians typically spend 45 minutes at the bedside and on the patient’s
floor or unit.
99307
Subsequent nursing facility care, per day, for the evaluation and management of a patient. Usually the patient is
stable, recovering or improving. Physicians typically spend 10 minutes at the bedside and on the patient’s floor or
unit.
99308
Subsequent nursing facility care, per day, for the evaluation and management of a patient. Usually the patient is
responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes
at the bedside and on the patient’s floor or unit.
99309
Subsequent nursing facility care, per day, for the evaluation and management of a patient. Usually the patient has
developed a significant complication or a significant new problem. Physicians typically spend 25 minutes at the
bedside and on the patient’s floor or unit.
99310
Subsequent nursing facility care, per day, for the evaluation and management of a patient. The patient may be
unstable or may have developed a significant new problem requiring immediate physician attention. Physicians
typically spend 35 minutes at the bedside and on the patient’s floor or unit.
99324
Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) of low severity. Physicians typically spend 20 minutes with the patient and/or family or caregiver.
99325
Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or
caregiver.
99326
Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or
caregiver.
99327
Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting
problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver.
99328
Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the patient has
developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes
with the patient and/or family or caregiver.
99334
Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting
problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or
caregiver.
99335
Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting
problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or
caregiver.
99336
Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting
CPT
CPT Description
problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or
caregiver.
99337
Domiciliary or rest home visit for the evaluation and management of an established patient. The patient may be
unstable or may have developed a significant new problem requiring immediate physician attention. Physicians
typically spend 60 minutes with the patient and/or family or caregiver.
HCPCS Codes [For guidance only]
HCPCS
Code Description
G0154
Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting,
each 15 minutes
G0155
Services of clinical social worker in home health or hospice settings, each 15 minutes
G0164
Skilled services of a licensed nurse, in the training and/or education of a patient or family member in
the home health or hospice setting