# G0506 documentation



## ivygirl18@hotmail.com

Hello,

Anybody billing G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services?

1. What documentation should the provider be doing? What's considered extensive? 

2. Should the diagnoses be the same between what the provider discussed for G0506 and what they will be following with the CCM services for 99490?

3. When a provider sees the patient for an E/M visit for their chronic conditions what more would they have to do to justify billing G0506 in addition? Create care plans with more documentation than what they normally do?

4. What if a provider billed a Medicare wellness, E/M, and G0506? Is this appropriate? Aren't they already going over their chronic conditions (assessment, plan, etc) for the E/M visit? What would they have to do more to justify billing G0506?

Any help would be greatly appreciated!


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## bnockis

We are also looking for some answers on this.  We have someone who potentially qualifies, but I was wondering what documentation is needed for the G0506, in addition to the documentation for the office visit they came in for.
TIA!


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## ivygirl18@hotmail.com

*G0506 more questions*

Can this service only be billed when the patient is either new or has not been seen in a year?

Can the nurse document in the nurse note or can it only be documented and/or performed by the provider?

Any help would be appreciated!


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## Cynthia Hughes

ivygirl18@hotmail.com said:


> Can this service only be billed when the patient is either new or has not been seen in a year?
> 
> Can the nurse document in the nurse note or can it only be documented and/or performed by the provider?
> 
> Any help would be appreciated!



 This is a physician or QHP service. Here is what CMS said in the final rule for the Medicare Physician Fee Schedule 2017:

"We also proposed for CY 2017 to create a new add-on G-code that would improve payment for services that qualify as initiating visits for CCM services. The code would be billable for beneficiaries who require extensive face-to-face assessment and care planning by the
billing practitioner (as opposed to clinical staff), through an add-on code to the initiating visit,G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed
separately from monthly care management services) (Add-on code, list separately in addition to primary service)). We proposed that when the billing practitioner initiating CCM personally performs extensive assessment and care planning outside of the usual effort described by the billed E/M code (or AWV or IPPE code), the practitioner could bill G0506 in addition to the E/M code for the initiating visit (or in addition to the AWV or IPPE), and in addition to the CCM CPT code 99490 (or proposed 99487 and 99489) if all requirements to bill for CCM services are also met.

We believed G0506 might be particularly appropriate to bill when the initiating visit is a less complex visit (such as a level 2 or 3 E/M visit), although G0506 could be billed along with higher level visits if the billing practitioner’s effort and time exceeded the usual effort
described by the initiating visit code. It could also be appropriate to bill G0506 when the initiating visit addresses problems unrelated to CCM, and the billing practitioner does not consider the CCM-related work he or she performs in determining what level of initiating visit to
bill. We believed that this proposal would more appropriately recognize the relative resource costs for the work of the billing practitioner in initiating CCM services, specifically for extensive work assessing the beneficiary and establishing the CCM care plan that is reasonable and necessary, and that is not accounted for in the billed initiating visit or in the unit of the CCM service itself that is billed for a given service period. In addition, we believed this proposal would help ensure that the billing practitioner personally performs and meaningfully contributes to the establishment of the CCM care plan when the patient’s complexity warrants it."


I have seen no documentation guidance other than what you can derive from this. Clearly the physician must personally develop the care plan for all health conditions and the work should go well beyond the typical work of the related initiating visit (e.g., an AWV is estimated to have 10 minutes of post-service time so 30 minutes of time spent in care planning in addition the AWV could be considered extensive). Would suggest proposing your questions to your MAC to get an official answer.

I hope that though not an answer, this is somewhat helpful.

Cindy


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## ivygirl18@hotmail.com

Cynthia Hughes said:


> This is a physician or QHP service. Here is what CMS said in the final rule for the Medicare Physician Fee Schedule 2017:
> 
> "We also proposed for CY 2017 to create a new add-on G-code that would improve payment for services that qualify as initiating visits for CCM services. The code would be billable for beneficiaries who require extensive face-to-face assessment and care planning by the
> billing practitioner (as opposed to clinical staff), through an add-on code to the initiating visit,G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed
> separately from monthly care management services) (Add-on code, list separately in addition to primary service)). We proposed that when the billing practitioner initiating CCM personally performs extensive assessment and care planning outside of the usual effort described by the billed E/M code (or AWV or IPPE code), the practitioner could bill G0506 in addition to the E/M code for the initiating visit (or in addition to the AWV or IPPE), and in addition to the CCM CPT code 99490 (or proposed 99487 and 99489) if all requirements to bill for CCM services are also met.
> 
> We believed G0506 might be particularly appropriate to bill when the initiating visit is a less complex visit (such as a level 2 or 3 E/M visit), although G0506 could be billed along with higher level visits if the billing practitioner’s effort and time exceeded the usual effort
> described by the initiating visit code. It could also be appropriate to bill G0506 when the initiating visit addresses problems unrelated to CCM, and the billing practitioner does not consider the CCM-related work he or she performs in determining what level of initiating visit to
> bill. We believed that this proposal would more appropriately recognize the relative resource costs for the work of the billing practitioner in initiating CCM services, specifically for extensive work assessing the beneficiary and establishing the CCM care plan that is reasonable and necessary, and that is not accounted for in the billed initiating visit or in the unit of the CCM service itself that is billed for a given service period. In addition, we believed this proposal would help ensure that the billing practitioner personally performs and meaningfully contributes to the establishment of the CCM care plan when the patient’s complexity warrants it."
> 
> 
> I have seen no documentation guidance other than what you can derive from this. Clearly the physician must personally develop the care plan for all health conditions and the work should go well beyond the typical work of the related initiating visit (e.g., an AWV is estimated to have 10 minutes of post-service time so 30 minutes of time spent in care planning in addition the AWV could be considered extensive). Would suggest proposing your questions to your MAC to get an official answer.
> 
> I hope that though not an answer, this is somewhat helpful.
> 
> Cindy


*Thank you very much for your response! This is very helpful!!*


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## Marisaeacobacci 

Can you report G0506 with TCM 99495/99496 on the same visit? Any help would be appreciated!


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## JULES80

Can you bill an office visit with G0506? I am getting a denial on G0506 with modifier 59 stating denied based on claims editing?


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## rthomas@impcna.com

JULES80 said:


> Can you bill an office visit with G0506? I am getting a denial on G0506 with modifier 59 stating denied based on claims editing?


Yes, your office visit needs a 25 modifier.  G0506 shouldn't need a modifier.


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